Independent of that financial reality, healthcare is also an inherently conservative sector. Patient safety naturally comes first. Change is approached cautiously, and new systems are expected to work reliably from day one. This is not a ‘fail fast’ industry, any fail that could negatively affect patient outcomes or healthcare professionals’ workflows must be avoided.
A third constraint is fragmentation. In many healthcare systems, responsibility is split across organizations, regions, and care settings, each with their own IT solutions, priorities and budgets. For the benefits of needed transformation to accrue across the wider system, tough decisions need to be made locally. That misalignment complicates the implementation of large-scale change.
The combination of these three factors – tight budgets, low tolerance for disruption, and system fragmentation – means that many organizations delay large-scale change, even when the limitations of existing systems are well understood.
Any digital transformation that succeeds in European healthcare must work within these constraints, not against them. It has to reduce long-term costs and risks. It must allow change to happen incrementally, without disrupting clinical work. And it must function in fragmented systems where no single organization controls the whole care pathway.
Lessons learned from the Nordics
In the Nordic countries, these issues have been addressed earlier than in many other parts of Europe. Over many years, we have built healthcare systems around shared data models, national integration layers, and strong interoperability.
Tieto Caretech has been directly involved in this development from the outset. Our clinical information system, Lifecare EHR, is now established and in broad use across 16 of Finland’s 21 wellbeing services counties, with significant and growing impact in Sweden and Norway – and momentum now starting to spread into the wider European market. The open platform that constitutes the foundation for this ecosystem, supports primary care, specialized care, and social care within a shared clinical data model. It underpins millions of patient interactions each year across the Nordic region.
Working at this scale, has only been possible thanks to our early choices around openness. By basing Lifecare EHR on the openEHR standard, we have been able to separate patient data from applications and care settings. This has allowed functionality to evolve over time, without the need for large-scale system replacements or disruptions to clinical work.
As a result, these healthcare systems have a level of data continuity that is still rare elsewhere in Europe. Clinicians can access relevant patient information regardless of where care was delivered. Data can also be reused responsibly for research, planning, and system improvement.
European regulation is now attempting to create similar conditions at scale. The European Health Data Space is an important step, but regulation alone will not solve the underlying problem of data fragmentation. Without open and interoperable foundations, new rules risk adding complexity rather than delivering value.
Working within Europe’s healthcare reality
Simply put, open standards allow healthcare organizations to evolve step by step, rather than forcing them into large, high-risk transformation programs. No single vendor can anticipate every future need, and no system should lock organizations into a fixed way of working for the next twenty years. Openness provides flexibility to accommodate change.
This matters most in highly decentralized healthcare systems. In most countries, hospitals and primary healthcare providers still operate as independent entities. No organization owns the full care pathway, and patients routinely move between providers, with little sharing of data. Transformation in this setting cannot be imposed centrally or delivered through a single, system-wide replacement. It has to happen incrementally.
Against this backdrop, Tieto Caretech is focused on bringing its openEHR applications to market across Europe through partnerships with local integrators. In fragmented healthcare systems, progress depends on working with organizations that understand national structures, regulatory requirements, and day-to-day operating realities. Open and modular foundations make change possible, while local actors are best positioned to improve their part of the system.
Artificial intelligence becomes more relevant once open architecture is in place. AI is essentially the stress test that exposes whether your digital foundations are fit for the future. Its value lies in the ability to automate routine work and support clinical decision-making. Implemented correctly, AI improves the use of scarce resources across the care landscape.
As existing core systems across Europe struggle to adapt to new demands, healthcare organizations face a choice: lock in today’s limitations for another generation or rethink the foundations. Improving healthcare outcomes and making better use of limited resources requires systems that are open, modular, and adaptable to change.
