Changes from adopted text to adopted text

RemovedRecital 4 a (new): (4a) The implementation of the EHDS should take into consideration the European ethical principles for digital health adopted by the eHealth network1a on 26 January 2022. Monitoring the application of those ethical principles should be one of the tasks of the EHDS Board. / 1a Established following Article 14 of Directive 2011/24/EU on the application of patients' rights in cross-border healthcare.

RemovedRecital 5: (5) More and more Europeans cross national borders to work, study, visit relatives or to travel. To facilitate the exchange of health data, and in line with the need for empowering citizens, they should be able to access their health data in an electronic format that can be recognised and accepted across the Union. Such personal electronic health data could include personal data related to the physical or mental health of a natural person, including the provision of health care services, which reveal information about their health status, personal data relating to the inherited or acquired genetic characteristics of a natural person which give unique information about the physiology or the health of that natural person and which result, in particular, from an analysis of a biological sample from the natural person in question, as well as data determinants of health, such as behaviour, environmental, physical influences, medical care, social or educational factors. Electronic health data also includes data that has been initially collected for research, statistics, health threat assessment, policy making or regulatory purposes and may be made available according to the rules in Chapter IV. The electronic health data concern all categories of those data, irrespective to the fact that such data is provided by the data subject or other natural or legal persons, such as health professionals, or is processed in relation to a natural person’s health or well-being and should also inc…

RemovedRecital 5 a (new): (5a) The scope of this Regulation should not cover natural persons who are not Union citizens, or third-country nationals not legally residing on the territory of the Member States. Therefore, where Member States require electronic registration of health data or where health data holders register health data regarding those natural persons, processors can only process the electronic health data of such persons, in accordance with Articles 6(1) and 9(2) of Regulation (EU) 2016/679 including for any secondary use.

RemovedRecital 7: (7) In health systems, personal electronic health data is usually gathered in electronic health records, which typically contain a natural person’s medical history, diagnoses and treatment, medications, allergies, immunisations, as well as radiology images and laboratory results, and other complementary diagnosis and therapeutics results, spread between different entities from the health system (general practitioners, hospitals, pharmacies, care services). In order to enable that electronic health data to be accessed, shared and changed by the natural persons or health professionals, some Member States have taken the necessary legal and technical measures and set up centralised infrastructures connecting EHR systems used by healthcare providers and natural persons. Alternatively, some Member States support public and private healthcare providers to set up personal health data spaces to enable interoperability between different healthcare providers. Several Member States have also supported or provided health data access services for patients and health professionals (for instance through patients or health professional portals). They have also taken measures to ensure that EHR systems or wellness applications are able to transmit electronic health data with the central EHR system (some Member States do this by ensuring, for instance, a system of certification). However, not all Member States have put in place such systems, and the Member States that have implemented them have…

RemovedRecital 9: (9) At the same time, it should be considered that immediate access of natural persons to certain types of their personal electronic health data may be harmful for the safety of natural persons, unethical or inappropriate. For example, it could be unethical to inform a patient through an electronic channel about a diagnosis with an incurable disease that is likely to lead to their swift passing instead of providing this information in a consultation with the patient first. Therefore, a possibility for limited exceptions in the implementation of this right should be ensured. Such an exception may be imposed by the Member States where this exception constitutes a necessary and proportionate measure in a democratic society, in line with the requirements of Article 23 of Regulation (EU) 2016/679. Such restrictions should be implemented by delaying the display of the concerned personal electronic health data to the natural person for a limited period, for instance until the moment where the patient and the health professional get in contact. Member States should be encouraged to require that health data available prior to the implementation of this Regulation be converted into an electronic format through a process facilitated by Member States. Any digital transformation in the healthcare sector should aim to be inclusive and benefit also natural persons with limited ability to access and use digital services. Natural persons should be able to provide an authorisation to the natur…

RemovedRecital 10: (10) Some Member States allow natural persons to add electronic health data to their EHRs or to store additional information in their separate personal health record that can be accessed by health professionals. However, this is not a common practice in all Member States and therefore should be established by the EHDS across the EU. Information inserted by natural persons may not be as reliable as electronic health data entered and verified by health professionals and does not have the same clinical or legal value as information provided by a health professional, therefore it should be clearly marked to indicate the source of such additional data and should be validated only by a health professional. More specifically, relevant fields in the EHR should be clearly marked. Enabling natural persons to more easily and quickly access their electronic health data also further enables them to notice possible errors such as incorrect information or incorrectly attributed patient records and have them rectified using their rights under Regulation (EU) 2016/679. In such cases, natural person should be enabled to request rectification of the incorrect electronic health data online, immediately and free of charge, for example through the personal health data access service. Data rectification requests should be assessed and, where relevant, implemented by the data controllers on case by case basis, if necessary involving health professionals, with a relevant specialisation, responsible f…

RemovedRecital 11: (11) Natural persons should be further empowered to exchange and to provide access to personal electronic health data to the health professionals of their choice, going beyond the right to data portability as established in Article 20 of Regulation (EU) 2016/679 and to download their health data. This is necessary to tackle objective difficulties and obstacles in the current state of play. Under Regulation (EU) 2016/679, portability is limited only to data processed based on consent or contract, which excludes data processed under other legal bases, such as when the processing is based on law, for example when their processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. It only concerns data provided by the data subject to a controller, excluding many inferred or indirect data, such as diagnoses, or tests. Finally, under Regulation (EU) 2016/679, the natural person has the right to have the personal data transmitted directly from one controller to another only where technically feasible. That Regulation, however, does not impose an obligation to make this direct transmission technically feasible. All these elements limit the data portability and may limit its benefits for provision of high-quality, safe and efficient healthcare services to the natural person.

RemovedRecital 12: (12) Natural persons should be able to exercise control over the transmission of personal electronic health data to other healthcare providers. Healthcare providers and other organisations providing EHRs should facilitate the exercise of this right. Stakeholders such as healthcare providers, digital health service providers, manufacturers of EHR systems or medical devices should not limit or block the exercise of the right of portability because of the use of proprietary standards or other measures taken to limit the portability. In accordance with Regulation (EU) 2016/679, healthcare providers should follow the data minimisation principle when accessing personal health data, limiting the data accessed to data that are strictly necessary and justified for a given service. For these reasons, the framework laid down by this Regulation builds on the right to data portability established in Regulation (EU) 2016/679 by ensuring that natural persons as data subjects can transmit their electronic health data, including inferred data, irrespective of the legal basis for processing the electronic health data. This right should apply to electronic health data processed by public or private controllers, irrespective of the legal basis for processing the data under in accordance with the Regulation (EU) 2016/679. This right should apply to all electronic health data.

AddedP9_TC1-COD(2022)0140

RemovedRecital 13: (13) Natural persons may not want to allow access to some parts of their personal electronic health data while enabling access to other parts. Such selective sharing of personal electronic health data should be supported. However, natural persons should be informed of the patient safety risks associated with limiting access to health data. However, such restrictions may have life threatening consequences and, therefore, access to personal electronic health data should be possible to protect vital interests as an emergency override. According to Regulation (EU) 2016/679, vital interests refer to situations in which it is necessary to protect an interest which is essential for the life of the data subject or that of another natural person. Processing of personal electronic health data based on the vital interest of another natural person should in principle take place only where the processing cannot be manifestly based on another legal basis. More specific legal provisions on the mechanisms of restrictions placed by the natural person on parts of their personal electronic health data should be provided by Member States in national law, in particular as regards medical liability in the event that restrictions have been placed by the natural person, Because the unavailability of the restricted personal electronic health data may impact the provision or quality of health services provided to the natural person, he/she should assume responsibility for the fact that the healthcare …

AddedPosition of the European Parliament adopted at first reading on 24 April 2024 with a view to the adoption of Regulation (EU) 2025/… of the European Parliament and of the Council on the European Health Data Space and amending Directive 2011/24/EU and Regulation (EU) 2024/2847

RemovedRecital 14: (14) In the context of the EHDS, natural persons should be able to exercise their rights under this Regulation without prejudice to Regulation (EU) 2016/679. The supervisory authorities established pursuant to Article 51 of Regulation (EU) 2016/679 should remain competent, in particular to monitor the processing of personal electronic health data and to address any complaints lodged by the natural persons. In order to carry out their tasks in the health sector and uphold the natural persons’ rights, digital health authorities should cooperate with the supervisory authorities under Regulation (EU) 2016/679.

Added(As an agreement was reached between Parliament and Council, Parliament's position corresponds to the final legislative act, Regulation (EU) 2025/327.)

RemovedRecital 15: (15) Article 9(2), point (h), of Regulation (EU) 2016/679 provides for exceptions where the processing of sensitive data is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health care or treatment or the management of health care systems and services on the basis of Union or Member State law. This Regulation should provide conditions and safeguards for the processing of electronic health data by healthcare providers and health professionals in line with Article 9(2), point (h), of Regulation (EU) 2016/679 with the purpose of accessing personal electronic health data provided by the natural person or transmitted from other healthcare providers. However, this Regulation should be without prejudice to the national laws concerning the processing of health data outside the scope of this Regulation, including for other secondary use purposes established by this Regulation, including the legislation establishing categories of health professionals that can process different categories of electronic health data.

RemovedRecital 16: (16) Timely and full access of health professionals to the medical records of patients is fundamental for ensuring continuity of care, avoiding duplications and errors and reducing costs. However, due to a lack of interoperability, in many cases, health professionals cannot access the complete medical records of their patients and cannot make optimal medical decisions for their diagnosis and treatment, which adds considerable costs for both health systems and natural persons and may lead to worse health outcomes for natural persons. Electronic health data made available in interoperable format, which can be transmitted between healthcare providers can also reduce the administrative burden on health professionals of manually entering or copying health data between electronic systems. Therefore, health professionals should be provided with appropriate electronic means, such as appropriate electronic and digital devices and health professional portals, to use personal electronic health data for the exercise of their duties on a need-to-know basis. Moreover, the access to personal health records should be transparent to the natural persons and natural persons should be able to exercise full control over such access, including by limiting access to all or part of the personal electronic health data in their records. Health professionals should refrain from hindering the implementation of the rights of natural persons, such as refusing to take into account electronic health data or…

RemovedRecital 16 a (new): (16a) Health professionals are faced with a profound change in the context of digitalisation and implementation of the EHDS. Health professionals need to develop their digital health literacy and digital skills. Therefore, health professionals who qualify as micro enterprises, as defined in Article 2 of the Annex to Commission Recommendation 2003/361/EC1a, should be temporarily exempted from the obligations laid down in this Regulation, in order to avoid a disproportionate administrative burden for micro enterprises. During the period of exemption, Member States should enable health professionals working as micro enterprises to take digital literacy courses to be able to prepare to work in EHR systems. / 1a Commission Recommendation of 6 May 2003 concerning the definition of micro, small and medium sized enterprises (OJ L 124, 20.5.2003, p. 36)

RemovedRecital 17: (17) The relevance of different categories of electronic health data for different healthcare scenarios varies. Different categories have also achieved different levels of maturity in standardisation, and therefore the implementation of mechanisms for their exchange may be more or less complex depending on the category. Therefore, the improvement of interoperability and data sharing should be gradual and prioritisation of categories of electronic health data is needed. Categories of electronic health data such as patient summary, electronic prescription and dispensation, laboratory results and reports, hospital discharge reports, medical images and reports have been selected by the eHealth Network as most relevant for the majority of healthcare situations and should be considered as priority categories for Member States to implement access to them and their transmission. When further needs for the exchange of more categories of electronic health data are identified for healthcare purposes, the list of priority categories should be expanded, after analysing relevant aspects related to the necessity and possibility for the exchange of new datasets, such as their support by systems established nationally or regionally by the Member States. Particular attention should be given to the data exchange in border regions of neighbouring Member States where the provision of cross-border health services is more frequent and needs even quicker procedures than across the Union in general.

RemovedRecital 19: (19) The level of availability of personal health and genetic data in an electronic format varies between Member States. The EHDS should make it easier for natural persons to have those data available in electronic format as well as for them to have better control over accessing and sharing their personal electronic health data. This would also contribute to the achievement of the target of 100% of Union citizens having access to their electronic health records by 2030, as referred to in the Policy Programme “Path to the Digital Decade”. In order to make electronic health data accessible and transmissible, such data should be accessed and transmitted in an interoperable common European electronic health record exchange format, at least for certain categories of electronic health data, such as patient summaries, electronic prescriptions and dispensations, medical images and image reports, laboratory results and discharge reports, subject to transition periods. Where personal electronic health data is made available to a healthcare provider or a pharmacy by a natural person, or is transmitted by another data controller in the European electronic health record exchange format, the electronic health data should be read and accepted for the provision of healthcare or for dispensation of a medicinal product, thus supporting the provision of the health care services or the dispensation of the electronic prescription. Commission Recommendation (EU) 2019/24345 provides the foundations…

RemovedRecital 20: (20) While EHR systems are widely spread, the level of digitalisation of health data varies in Member States depending on data categories and on the coverage of healthcare providers that register health data in electronic format. In order to support the implementation of data subjects’ rights of access to and exchange of electronic health data, Union action is needed to avoid further fragmentation. In order to contribute to a high quality and continuity of healthcare, certain categories of health data should be registered in electronic format systematically and according to specific data quality requirements. The European electronic health record exchange format should form the basis for specifications related to the registration and exchange of electronic health data. The Commission should be empowered to adopt delegated acts for determining data quality requirements.

RemovedRecital 20 a (new): (20a) In order to support the successful implementation of the EHDS and the creation of effective conditions for European health data cooperation, the Commission and Member States should agree on time-based targets to implement conditions for improved health data interoperability across the Union with a range of objectives and milestones, including in respect of disease-specific registry interoperability, which should be reviewed and assessed in an annual report.

RemovedRecital 21: (21) Under Article 168 of the Treaty on the Functioning of the European Union (TFEU), Member States are responsible for their health policy, in particular for decisions on the services that they provide and reimburse. Different reimbursement policies should, however, not constitute barriers to the free movement of digital health services such as telemedicine, including online pharmacy services. When digital services accompany the physical provision of a healthcare service, the digital service should be included in the overall care provision. Telemedicine is becoming an increasingly important tool that can provide patients with access to care and tackle inequities and has the potential to reduce health inequalities and reinforce the free movement of Union citizens across borders. Digital and other technological tools can facilitate the provision of care in remote regions. However, telemedicine should not be viewed as a replacement for in-person medicine, as there are certain conditions and procedures that require in-person physical examination and intervention.

RemovedRecital 22: (22) Regulation (EU) No 910/2014 of the European Parliament and of the Council47 lays down the conditions under which Members States perform identification of natural persons in cross-border situations using identification means issued by another Member State, establishing rules for the mutual recognition of such electronic identification means. The EHDS requires a secure access to electronic health data, including in cross-border scenarios where the health professional and the natural person are from different Member States, to avoid cases of unauthorised access. At the same time, the existence of different means of electronic identification should not be a barrier for exercising the rights of natural persons and health professionals. Therefore, natural persons and health professionals should have the right to electronic identification using any recognised electronic identification, including eID schemes where such are offered. The rollout of interoperable, cross-border identification and authentication mechanisms for natural persons and health professionals across the EHDS requires strengthening cooperation at Union level in the European Health Data Space Board (‘EHDS Board’). As the rights of the natural persons in relation to the access and transmission of personal electronic health data should be implemented uniformly across the Union, a strong governance and coordination is necessary at both Union and Member State level.

RemovedRecital 22 a (new): (22a) Member States should establish relevant digital health authorities for the planning and implementation of standards for electronic health data access and transmission and the enforcement of the rights of natural persons and health professionals. In addition, governance elements are needed in Member States to facilitate the participation of national actors in the cooperation at Union level, channelling expertise and advising on the design of solutions necessary to achieve the goals of the EHDS. Digital health authorities exist in most of the Member States and they deal with EHRs, interoperability, security or standardisation. Digital health authorities should be established in all Member States, as separate organisations or as part of currently existing authorities.

RemovedRecital 23: (23) Digital health authorities should have sufficient technical skills, possibly bringing together experts from different organisations. The activities of digital health authorities should be well-planned and monitored in order to ensure their efficiency. Digital health authorities should take necessary measures to ensuring rights of natural persons by setting up national, regional, and local technical solutions such as national EHR, patient portals, data intermediation systems. When doing so, they should apply common standards and specifications in such solutions, promote the application of the standards and specifications in procurements and use other innovative means including reimbursement of solutions that are compliant with interoperability and security requirements of the EHDS. Member States should ensure that appropriate training initiatives are undertaken. In particular, health professionals should be informed and trained with respect to their rights and obligations under this Regulation. To carry out their tasks, the digital health authorities should cooperate at national and Union level with other entities, including with insurance bodies, healthcare providers, health professionals, manufacturers of EHR systems and wellness applications, as well as other stakeholders from health or information technology sector, entities handling reimbursement schemes, health technology assessment bodies, medicinal products regulatory authorities and agencies, medical devices auth…

RemovedRecital 24: (24) Access to and transmission of electronic health data is relevant in cross-border healthcare situations, as it may support continuity of healthcare when natural persons travel to other Member States or change their place of residence. Continuity of care and rapid access to personal electronic health data is even more important for residents in border regions, crossing the border frequently to get health care. In many border regions, some specialised health care services may be available closer across the border rather than in the same Member State. An infrastructure is needed for the transmission of personal electronic health data across borders, in situations where a natural person is using services of a healthcare provider established in another Member State. A voluntary infrastructure for that purpose, MyHealth@EU, has been established as part of the actions provided for in Article 14 of Directive 2011/24/EU. Through MyHealth@EU, Member States started to provide natural persons with the possibility to share their personal electronic health data with healthcare providers when travelling abroad. To further support such possibilities, the participation of Member States in the digital infrastructure MyHealth@EU should become mandatory. All Member States should join the infrastructure and connect healthcare providers and pharmacies to it, as this is necessary for the implementation of the rights of natural persons to access and make use of their personal electronic health d…

RemovedRecital 25: (25) In the context of MyHealth@EU, a central platform should provide a common infrastructure for the Member States to ensure connectivity and interoperability in an efficient and secure way. In order to guarantee compliance with data protection rules and to provide a risk management framework for the transmission of personal electronic health data, the Commission should, by means of implementing acts, allocate specific responsibilities with time-based targets among the Member States, as joint controllers, and prescribe its own obligations, as processor.

RemovedRecital 26: (26) In addition to services in MyHealth@EU for the exchange of personal electronic health data based on the European electronic health record exchange format, other services or supplementary infrastructures may be needed for example in cases of public health emergencies or where the architecture of MyHealth@EU is not suitable for the implementation of some use cases. Examples of such use cases include support for vaccination card functionalities, including the exchange of information on vaccination plans, or verification of vaccination certificates or other health-related certificates. This would be also important for introducing additional functionality for handling public health crises, such as support for contact tracing for the purposes of containing infectious diseases.

RemovedRecital 34 a (new): (34a) EHR systems could qualify as medical devices under Regulation (EU) 2017/745 or in-vitro diagnostic devices under Regulation (EU) 2017/746 of the European Parliament and of the Council1a. While those EHR systems need to fulfil the requirements under each applicable regulation, Member States should take appropriate measures to ensure that the respective conformity assessment is carried out as a joint or coordinated procedure, as appropriate, inter alia by encouraging the same notified bodies to become responsible for the conformity assessment under each applicable regulation. / 1a Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU (OJ L 117, 5.5.2017, p. 176).

RemovedRecital 35: (35) Users of wellness applications, such as mobile applications, should be informed about the capacity of such applications to be connected and to supply data to EHR systems or to national electronic health solutions, in cases where data produced by wellness applications is useful for healthcare purposes. The capability of those applications to export data in an interoperable format is also relevant for data portability purposes. Where applicable, users should be informed about the compliance of such applications with interoperability and security requirements. However, given the large number of wellness applications and the limited relevance for healthcare purposes of the data produced by many of them, a certification scheme for these applications would not be proportionate. A mandatory labelling scheme for wellness applications claiming interoperability with EHR systems should therefore be established as an appropriate mechanism for enabling the transparency for the users of wellness applications regarding compliance with the requirements, thereby supporting users in their choice of appropriate wellness applications with high standards of interoperability and security. The Commission should set out in implementing acts the details regarding the format and content of such label.

RemovedRecital 36 a (new): (36a) The uptake of real-world data and real-world evidence, including patient-reported outcomes, for evidence-based regulatory and policy purposes as well as for research, health technology assessment and clinical objectives should be encouraged. Real-world data and real-world evidence have the potential to complement health data currently made available.

RemovedRecital 37: (37) For the secondary use of personal electronic health data for research, innovation, policy making, regulatory purposes, patient safety or the treatment of other natural persons, the possibilities offered by Regulation (EU) 2016/679 for a Union law should be used as a basis for rules and mechanisms providing suitable and specific measures to safeguard the rights and freedoms of the natural persons. For the purpose of processing electronic health data for secondary use, one of the legal bases set out in Article 6(1), points (a), (c), (e) or (f), of Regulation (EU) 2016/679 combined with Article 9(2) of that Regulation should be required. The most relevant processing condition listed in Article 9(2) of Regulation (EU) 2016/679 in this context is that of substantial public interest, the provision of health or social care, public interest in the area of public health and research. Hence, this Regulation provides the legal basis in accordance with Article 6 and Articles 9(2) (g), (h), (i) and (j) of Regulation (EU) 2016/679 for the secondary use of health data, establishing the safeguards for processing, in terms of lawful purposes, trusted governance for providing access to health data (through health data access bodies) and processing in a secure environment, as well as modalities for data processing, set out in the data permit. More specifically, for processing of electronic health data held by the health data holder pursuant to this Regulation, this Regulation creates the l…

RemovedRecital 37 a (new): (37a) In the case where the health data user has access to electronic health data for secondary use of data for one of the purposes defined in this Regulation, the health data user should demonstrate the specific legal ground on which it relies as part of the application for access to electronic health data pursuant to this Regulation, namely, on the basis of the applicable law, where the legal basis under Regulation (EU) 2016/679 is Article 6(1), point (e), or Article 6(1), point (f), thereof. If the health data user relies upon the ground provided for in Article 6(1), point (e), it should make reference to another Union or national law, requiring the user to process personal health data for the compliance of its tasks. If the ground for processing by the health data user is Article 6(1), point (f), of Regulation (EU) 2016/679, appropriate and necessary safeguards should be determined in accordance with this Regulation. In this context, the data permits issued by the health data access bodies should be an administrative decision defining the conditions for the access to the data.

RemovedRecital 38: (38) In the context of the EHDS, the electronic health data already exists and is being collected by healthcare providers, professional associations, public institutions, regulators, researchers, insurers etc. in the course of their activities. Some categories of data are collected primarily for the provisions of healthcare (e.g. electronic health records, genetic data, claims data, etc.), others are collected also for other purposes such as research, statistics, patient safety, regulatory activities or policy making (e.g. disease registries, policy making registries, registries concerning the side effects of medicinal products or medical devices, etc.). For instance, European databases that facilitate data (re)use are available in some areas, such as cancer (European Cancer Information System) or rare diseases (European Platform on Rare Disease Registration, ERN registries, etc.). These data should also be made available for secondary use. However, much of the existing health-related data is not made available for purposes other than that for which they were collected. This limits the ability of researchers, innovators, policy-makers, regulators and doctors to use those data for different purposes, including research, innovation, policy-making, regulatory purposes, patient safety or personalised medicine. In order to fully unleash the benefits of the secondary use of electronic health data, all health data holders should contribute to this effort in making different categori…

RemovedRecital 39: (39) The categories of electronic health data that can be processed for secondary use should be broad and flexible enough to accommodate the evolving needs of health data users, while remaining limited to data related to health or known to influence health. It can also include relevant data from the health system (electronic health records, claims data, disease registries, genomic data etc.), as well as data with an impact on health (for example consumption of different substances, socio-economic status, behaviour, including environmental factors (for example, pollution, radiation, use of certain chemical substances). They can also include automatically generated data from medical devices and person-generated data, such as wellness applications. The health data user who benefits from access to datasets provided under this Regulation could enrich the data with various corrections, annotations and other improvements, for instance by supplementing missing or incomplete data, thus improving the accuracy, completeness or quality of data in the dataset. Health data users should be encouraged to report critical errors in datasets to health data access bodies. To support the improvement of the original database and further use of the enriched dataset, the dataset with such improvements and a description of the changes should be made available free of charge to the original data holder. The data holder should make available the new dataset, unless it provides a justified notification …

RemovedRecital 39 a (new): (39a) In order to guarantee trust in the patient-physician relationship, the principle of professional secrecy and the patient's right to confidentiality should be safeguarded when digitalising healthcare services. A relationship of trust between patients and health professionals and healthcare providers and other holders of personal health data is a paramount element of the provision of health or social care or treatment. It is within that context that the patient or the legal representative of the patient should have a say in the processing of their health data for secondary use in the form of a right to opt-out of the processing of all or parts of their health data for secondary use for some or all purposes. An easily understandable and accessible opt-out mechanism in a user-friendly format should be provided for in this regard. However, due to the sensitive nature of human genetic, genomic and proteomic data, data from biobanks and to the nature of the use of data from wellness applications, it is appropriate to provide that the secondary use of such data can only occur following the consent of the natural person concerned in accordance with Article 4(11) of the Regulation (EU) 2016/679. An opt-in mechanism whereby data subjects explicitly consent or give their permission to the processing of part or all of such data for some or all secondary use purposes should be envisaged. Where data subjects explicitly consent to the use of parts or all of this data for some or all se…

RemovedRecital 40: (40) The health data holders in the context of secondary use of electronic health data can be public, non for profit or private health or care providers, public, non for profit and private organisations, associations or other entities, public and private entities that carry out research with regards to the health sector that process the categories of health and health related data mentioned above To the extent that they process personal electronic health data, health data holders are controllers within the meaning of Regulation (EU) 2016/679 in the health or care sector. In order to avoid a disproportionate burden on small entities, micro-enterprises are excluded from the obligation to make their data available for secondary use in the framework of EHDS. Health data access bodies should provide specific support to small enterprises, in particular medical practitioners and pharmacies, in complying with their obligation to make data available for secondary use. The public or private entities often receive public funding, from national or Union funds to collect and process electronic health data for research, statistics (official or not) or other similar purposes, including in area where the collection of such data is fragmented of difficult, such as rare diseases, cancer etc. Such data, collected and processed by health data holders with the support of Union or national public funding, should be made available by health data holders to health data access bodies, in order to max…

RemovedRecital 40 a (new): (40a) Different demographic groups have varying degrees of digital literacy, which can affect natural persons’ ability to exercise their rights to control their electronic health data. In addition to the right for natural persons to authorise another natural person of their choice to access or control their electronic health data on their behalf, Member States should create targeted national digital literacy programmes, including programmes to maximise social inclusion and to ensure all natural persons can effectively exercise their rights under this Regulation. Member States should also provide patient-centric guidance to natural persons in relation to the use of electronic health records and primary use of their personal electronic health data. Guidance should be tailored to the patient’s level of digital health literacy, with specific attention to be given to the needs of vulnerable groups.

RemovedRecital 40 b (new): (40b) Clinical trials and studies are of utmost importance in fostering innovation within the Union for the benefit of Union patients. In order to incentivise continuous Union leadership in this domain, the sharing of the clinical trials data through the EHDS for secondary use should be consistent with the relevant transparency provisions laid down in Union law including Regulation (EU) .../... [proposal for a Regulation on blood, tissue, cells and organs (SoHO) COM(2022)338 final], Regulations (EC) No 726/20041a and (EU) 2019/61b of the European Parliament and of the Council and Directive 2001/83/EC of the European Parliament and of the Council1c regarding veterinary and human medicines and establishing the EMA, Regulation (EC) No 141/2000 of the European Parliament and of the Council1d related to medicinal products for rare diseases (‘orphan medicines’), Regulation (EC) No 1901/2006 of the European Parliament and of the Council1e on medicinal products for children, Regulation (EC) No 1394/2007 of the European Parliament and of the Council1f on advanced therapy medicinal products, Regulation (EU) No 536/2014 of the European Parliament and of the Council1g on clinical trials, Regulation (EU) No 2017/745 and Regulation (EU) No 2017/746. / 1a Regulation (EC) No 726/2004 of the European Parliament and of the Council of 31 March 2004 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a Europea…

RemovedRecital 41: (41) The secondary use of health data under EHDS should enable the public, private, not for profit entities, as well as individual researchers, with a demonstrated link to the field of public health, to have access to health data for research, innovation, policy making, educational activities, patient safety, regulatory activities or personalised medicine, in line with the purposes set out in this Regulation. Access to data for secondary use should contribute to the general interest of the society. In particular, the secondary use of health data for research and development purposes should contribute to a benefit to society in the form of new medicines, medical devices, health care products and services at affordable and fair prices for Union citizens, as well as to enhancing access to and the availability of such products and services in all Member States. Activities for which access in the context of this Regulation is lawful may include using the electronic health data for tasks carried out by public bodies, such as exercise of public duty, including public health surveillance, planning and reporting duties, health policy making, ensuring patient safety, quality of care, and the sustainability of health care systems. Public bodies and Union institutions, bodies, offices and agencies may require to have regular access to electronic health data for an extended period of time, including in order to fulfil their mandate, which is provided by this Regulation. Public sector bodi…

RemovedRecital 42: (42) The establishment of one or more health data access bodies, supporting access to electronic health data in Member States, is an essential component for promoting the secondary use of health-related data. Member States should therefore establish one or more health data access body, for instance to reflect their constitutional, organisational and administrative structure. However, one of these health data access bodies should be designated as a coordinator in case there are more than one data access body. Where a Member State establishes several bodies, it should lay down rules at national level to ensure the coordinated participation of those bodies in the EHDS Board. That Member State should in particular designate one health data access body to function as a single contact point for the effective participation of those bodies, and ensure swift and smooth cooperation with other health data access bodies, the EHDS Board and the Commission. Health data access bodies may vary in terms of organisation and size (spanning from a dedicated full-fledged organization to a unit or department in an existing organization) but should have the same functions, responsibilities and capabilities. Health data access bodies should not be influenced in their decisions on access to electronic data for secondary use, Members of the governance and decision-making bodies and staff of each health data access body should therefore refrain from any action that is incompatible with their duties and…

RemovedRecital 43: (43) The health data access bodies should monitor the application of Chapter IV of this Regulation and contribute to its consistent application throughout the Union. For that purpose, the health data access bodies should cooperate with each other and with the Commission, without the need for any agreement between Member States on the provision of mutual assistance or on such cooperation. The health data access bodies should also cooperate with stakeholders, including patient organisations. The selection procedure for health stakeholders should be transparent, public and free of any conflict of interest. Since the secondary use of health data involves the processing of personal data concerning health, the relevant provisions of Regulation (EU) 2016/679 apply and the supervisory authorities under Regulation (EU) 2016/679 and Regulation (EU) 2018/1725 should remain the only authorities competent for enforcing these rules. Moreover, given that health data are sensitive data and in a duty of loyal cooperation, the health data access bodies should inform the data protection authorities of any issues related to the data processing for secondary use, including administrative fines and enforcement measures. In addition to the tasks necessary to ensure effective secondary use of health data, the health data access body should strive to expand the availability of additional health datasets, and promote the development of common standards. They should apply tested state-of-the-art techni…

RemovedRecital 44: (44) Health data access bodies should comply with the obligations laid down in Article 14 of Regulation (EU) 2016/679 and inform the natural persons whose data are used in data projects within a secure processing environment. The exceptions provided for in Article 14(5) of Regulation (EU) 2016/679 could apply. Where such exceptions are applied, health data access bodies should provide general information concerning the conditions for the secondary use of their health data containing the information items listed in Article 14(1) and, where necessary to ensure fair and transparent processing, Article 14(2) of Regulation (EU) 2016/679, e.g. information on the purpose and the data categories processed, enabling natural persons to understand whether their data are being made available for secondary use pursuant to data permits. Exceptions from this rule should be made when the results of the research could assist in the treatment of the natural person concerned. In this case, the health data user should inform the health data access body, which should inform the health professional treating the natural person concerned or, in the event that the treating health professional is not traceable, the natural person, with due regard for their stated wish not to be informed, while fully respecting the principles of medical confidentiality and professional secrecy. Natural persons should be able to access the results of different research projects on the website of the health data access b…

RemovedRecital 46: (46) In order to support the secondary use of electronic health data, the data holders should refrain from withholding the data, requesting unjustified fees that are not transparent nor proportionate with the costs for making data available (and, where relevant, with marginal costs for data collection), requesting the data users to co-publish the research or other practices that could dissuade the data users from requesting the data. Where ethical approval is necessary for providing a data permit, its evaluation should be based on its own merits. On the other hand, public sector bodies and Union institutions, bodies, offices and agencies with a legal mandate in the field of public health, have very important and insightful data. Access to data of such institutions, bodies, offices and agencies should be granted through the health data access body where the controller is located.

RemovedRecital 47: (47) Health data access bodies should be allowed to charge fees based on the applicable provisions under this Regulation and the provisions of Regulations (EU) .../... […] [Data Governance Act COM/2020/767 final] and (EU) .../... […] [Data Act COM/2022/68 final] in relation to their tasks. Such fees may take into account the situation and interest of SMEs, individual researchers or public bodies. Health data holders should be allowed to also charge fees for making data available. Such fees should reflect the costs for providing such services. Private health data holders may also charge fees for the collection of data. In order to ensure a harmonised approach concerning fee policies and structure, the Commission should adopt implementing acts. Provisions in Article 10 of the Regulation [Data Act COM/2022/68 final] should apply for fees charged under this Regulation. Public sector bodies and Union institutions, bodies, offices and agencies with a legal mandate in the field of public health should not be charged fees.

RemovedRecital 48: (48) In order to strengthen the enforcement of the rules on the secondary use of electronic health data, appropriate measures should be envisaged that can lead to administrative fines or enforcement measures by health data access bodies or temporary or definitive exclusions from the EHDS framework of the health data users or health data holders that do not comply with their obligations. The health data access body should be empowered to verify compliance and give health data users and holders the opportunity to reply to any findings and to remedy any infringement. When deciding on the amount of the administrative fine or enforcement measure for each individual case, health data access bodies should take into account the margins for costs and criteria set out in this Regulation.

RemovedRecital 49: (49) Given the sensitivity of electronic health data, it is necessary to reduce risks on the privacy of natural persons by applying the data minimisation principle as set out in Article 5 (1), point (c) of Regulation (EU) 2016/679. Therefore, common standards for data anonymisation should be further developed and the use of anonymised electronic health data which is devoid of any personal data should be made available when possible. If the data user needs to use personal electronic health data, it should clearly indicate in its request the justification for the use of this type of data for the planned data processing activity and the health data access body should determine the validity of that justification. The personal electronic health data should only be made available in pseudonymised format and the encryption key can only be held by the health data access body. When providing access to an anonymised or pseudonymised dataset, a health data access body should use state-of-the-art anonymisation or pseudonymisation technology, ensuring to the maximum extent possible that natural persons cannot be re-identified. Health data users should not attempt to re-identify natural persons from the dataset provided under this Regulation, subject to administrative fines and the enforcement measures laid down in this Regulation or possible criminal penalties, where the national laws foresee this. However, this should not prevent, in cases where the results of a project carried out based…

RemovedRecital 50: (50) In order to ensure that all health data access bodies issue permits in a similar way, it is necessary to establish a standard common process for the issuance of data permits, with similar requests in different Member States. The health data applicant should provide health data access bodies with several information elements that would help the body evaluate the application and decide if the applicant may receive a data permit for secondary use of data, also ensuring coherence between different health data access bodies. Such information includes: the legal basis under Regulation (EU) 2016/679 to request access to data (exercise of a task in the public interest assigned by law or legitimate interest), purposes for which the data would be used, the identity of the health data applicant as well as the specific persons who are authorised to have access to the electronic health data in the secure processing environment and how they are qualified vis-à-vis the intended secondary use, description of the needed data and possible data sources, a description of the tools needed to process the data, as well as characteristics of the secure environment that are needed, a description of the safeguards planned to prevent any other use, misuse or possible re-identification, and an explanation of the expected benefits of the secondary use. Where data is requested in pseudonymised format, the health data applicant should explain why this is necessary and why anonymous data would not suff…

RemovedRecital 50 a (new): (50a) A standard ethics assessment should be carried out by ethics bodies within health data access bodies. Such assessment should be an important part of the process. However, where the health data applicant had previously obtained the approval of the competent ethics committee in accordance with national law for research purposes for which they are requesting data through the EHDS, the health data applicant should make that information available to the health data access body as part of the data access application.

RemovedRecital 51: (51) As the resources of health data access bodies are limited, they can apply prioritisation rules, for instance prioritising public institutions before private entities, but they should not make any discrimination between the national or from organisations from other Member States within the same category of priorities. The health data user should be able to extend the duration of the data permit in order, for example, to allow access to the datasets to reviewers of scientific publication or to enable additional analysis of the dataset based on the initial findings. This would require an amendment of the health data permit and may be subject to an additional fee. However, in all the cases, the data permit should reflect theses additional uses of the dataset. Preferably, the health data user should mention them in their initial request for the issuance of the data permit. In order to ensure a harmonised approach between health data access bodies, the Commission should support the harmonisation of data permit.

RemovedRecital 52: (52) As the COVID-19 crisis has shown, the Union institutions, bodies, offices and agencies with a legal mandate in the field of public health, especially the Commission, need access to health data for a longer period and on a recurring basis. This may be the case not only for specific circumstances stipulated by Union or national law in times of crisis but also to provide scientific evidence and technical support for Union policies on a regular basis. Access to such data may be required in specific Member States or throughout the whole territory of the Union.

RemovedRecital 53: deleted

RemovedRecital 54: (54) Given the sensitivity of electronic health data, data users should not have an unrestricted access to such data, in accordance with the data minimisation principle. All secondary use access to the requested electronic health data should be done through a secure processing environment. In order to ensure strong technical and security safeguards for the electronic health data, the health data access body should provide access to such data in a secure processing environment, complying with the high technical and security standards set out pursuant to this Regulation. Some Member States took measures to locate such secure environments in Europe. The processing of personal data in such a secure environment should comply with Regulation (EU) 2016/679, including, where the secure environment is managed by a third party, the requirements of Article 28 and, where applicable, Chapter V. Nevertheless, in order to ensure the proper supervision and security of personal data, such environments need to be located in the Union if they are used to access personal health data. Such secure processing environment should reduce the privacy risks related to such processing activities and prevent the electronic health data from being transmitted directly to the data users. The health data access body or the data holder providing this service should remain at all time in control of the access to the electronic health data with access granted to the data users determined by the conditions of the…

RemovedRecital 55: (55) For the processing of electronic health data in the scope of a granted permit, the health data holders, the health data access bodies and the health data users should each, in turn, be deemed a controller for a specific part of the process and according to their respective roles therein. The health data holder should be deemed controller for the disclosure of the requested personal electronic health data to the health data access body, while the health data access body should in turn be deemed controller for the processing of the personal electronic health data when preparing the data and making them available to the health data user. The health data user should be deemed controller for the processing of personal electronic health data in pseudonymised form in the secure processing environment pursuant to its data permit. The health data access body should be deemed a processor for processing carried out by the health data user pursuant to a data permit in the secure processing environment. HealthData@EU should accelerate the secondary use of electronic health data while increasing legal certainty, respecting the privacy of natural persons and being interoperable. Due to the sensitivity of health data, principles such as “privacy by design”, “privacy by default”, and “bring questions to data instead of moving data” should be respected whenever possible. Authorised participants in HealthData@EU could be health data access bodies, research infrastructures established as an…

RemovedRecital 59: (59) Information on the quality and utility of datasets increases the value of outcomes from data intensive research and innovation significantly, while, at the same time, promoting evidence-based regulatory and policy decision-making. Improving the quality and utility of datasets through informed customer choice and harmonising related requirements at Union level, taking into account existing Union and international standards, guidelines, recommendations for data collection and data exchange (i.e. FAIR principles: Findable, Accessible, Interoperable and Reusable), benefits also data holders, health professionals, natural persons and the Union economy overall. A data quality and utility label for datasets would inform data users about the quality and utility characteristics of a dataset and enable them to choose the datasets that best fit their needs. The data quality and utility label should not prevent datasets from being made available through the EHDS, but provide a transparency mechanism between data holders and data users. For example, a dataset that does not fulfil any requirement of data quality and utility should be labelled with the class representing the poorest quality and utility, but should still be made available. Expectations set in frameworks described in Article 10 of Regulation […] [AI Act COM/2021/206 final] and its relevant documentation specified in Annex IV should be taken into account when developing the data quality and utility framework. The labels s…

RemovedRecital 61: (61) Cooperation and work is ongoing between different professional organisations, the Commission and other institutions to set up minimum data fields and other characteristics of different datasets (registries for instance). This work is more advanced in areas such as cancer, rare diseases, cardiovascular and metabolic diseases, risk factor assessment, and statistics and shall be taken into account when defining new standards and disease-specific harmonised templates for structured data elements. However, many datasets are not harmonised, raising comparability issues and making cross-border research difficult. Therefore, more detailed rules should be set out in implementing acts to ensure a harmonised provision, coding and registration of electronic health data. Member States should work towards delivering sustainable economic and social benefits of European electronic health systems and services and interoperable applications, with a view to achieving a high level of trust and security, enhancing continuity of healthcare and ensuring access to safe and high-quality healthcare. Existing health data infrastructures and registries put in place by institutions and stakeholders can contribute to defining and implementing data standards, to ensuring interoperability and should be leveraged to allow for continuity and build on existing expertise.

RemovedRecital 62 a (new): (62a) Improving digital health literacy for both natural persons and their health professionals is key in order to achieve trust, safety and appropriate use of health data and thus to achieve successful implementation of this Regulation. Improving digital health literacy is fundamental in order to empower natural persons to have true control over their health data and actively manage their health and care, and understand the implications of the management of such data for both primary and secondary use. Member States, including regional and local authorities, should therefore support digital health literacy and public awareness, while ensuring that the implementation of this Regulation contributes to reducing inequalities and does not discriminate against people lacking digital skills. Particular attention should be given to persons with disabilities and vulnerable groups including migrants and the elderly. Health professionals and IT operators should have sufficient training in working with new digital infrastructures to ensure cybersecurity and ethical management of health data.

RemovedRecital 63: (63) The use of funds should also contribute to attaining the objectives of the EHDS. Public procurers, national competent authorities in the Member States, including digital health authorities and health data access bodies, as well as the Commission should make references to applicable technical specifications, standards and profiles on interoperability, security and data quality, as well as other requirements developed under this Regulation when defining the conditions for public procurement, calls for proposals and allocation of Union funds, including structural and cohesion funds. To procure or fund services provided by controllers and processors established in the Union that process personal electronic health data, they should be required to demonstrate that they will store the data in the Union and that they are not subject to third country law that conflicts with Union data protection rules. Union funds should be distributed transparently and sufficiently among the Member States, ensuring it is adequate and taking into account different levels of health system digitalisation and the costs involved in making national data infrastructures interoperable and compatible with the requirements of the EHDS. Making data available for secondary use requires additional resources for healthcare systems, in particular public systems. That additional burden for public entities should be addressed and minimised to the greatest possible extent during the implementation phase of the EH…

RemovedRecital 63 a (new): (63a) The economic costs of implementing this Regulation should be borne at both Member State and Union level, and a fair sharing of that burden between national and Union funds should be found. The initial Union funding to achieve a timely application of the EHDS is limited to what can be mobilised under the 2021-2027 Multiannual Financial Framework (MFF) where EUR 220 million can be made available under the EU4Health and Digital Europe programmes. The successful and coherent application of the EHDS across all Member States will however require higher funding. The implementation of the EHDS requires appropriate investments in capacity building and training and a well-funded commitment to public consultation and engagement. The Commission should therefore mobilise further resources for the EHDS as part of the review of the 2021-2027 MFF and for the forthcoming MFF under the principle that new initiatives should be matched with new funding.

RemovedRecital 64 a (new): (64a) The functioning of the EHDS involves processing of a large quantity of personal and non-personal health data of a highly sensitive nature. Article 8(3) of the Charter of Fundamental Rights of the European Union (the ‘Charter’) requires control over the processing of such health data by an independent authority. The control of the compliance with the requirements of protection and security by an independent supervisory authority, carried out on the basis of Union law, is an essential component of the protection of individuals with regard to the processing of personal data and cannot be fully ensured in the absence of a requirement to retain the electronic health data in question within the Union. Therefore, taking into account the need to mitigate the risks of unlawful access and ineffective supervision, in compliance with the principle of proportionality, this Regulation should require Member States to store electronic health data within the Union. Such storage requirements should ensure a uniform high level of protection for data subjects across the Union, preserve the proper functioning of the internal market, in line with Article 114 TFEU, which constitutes the legal basis of this Regulation, and serve to enhance citizens’ trust in the EHDS.

RemovedRecital 64 b (new): (64b) The obligation to store electronic health data in the Union does not preclude transfers of those data to third countries or international organisations by means of granting access to electronic health data. Access to data through the secure processing environment can entail the transfer of personal data, as defined in Chapter V of Regulation (EU) 2016/679. It is possible to reconcile a general requirement to store personal data in the Union with specific transfers being allowed in compliance with Union law on personal data protection, for instance in the context of scientific research, provision of care or international cooperation. In particular, when personal data are transferred from the Union to controllers, processors or other recipients in third countries or to international organisations, the level of protection of natural persons ensured in the Union under Regulation (EU) 2016/679 should not be undermined, including in cases of onward transfers of personal data from the third country or international organisation to controllers, processors in the same or another third country or international organisation. Transfers of personal health data to third countries and international organisations can only be carried out in full compliance with Chapter V of Regulation (EU) 2016/679. For instance, controllers and processors processing personal electronic health data remain subject to Article 48 of that Regulation on transfers or disclosures not authorised by Union law an…

RemovedRecital 64 c (new): (64c) Access to electronic health data for entities from third countries should take place only on the basis of the reciprocity principle. Making available of health data to a third country can take place only where the Commission has established by means of a delegated act that the third country concerned allows for the use of health data by Union entities under the same conditions and with the same safeguards as within the Union. The Commission should monitor that list and provide for a periodic review thereof. Where the Commission finds that a third country no longer ensures access on the same terms, that third country should be removed from that list.

RemovedRecital 65: (65) In order to promote the consistent application of this Regulation, including cross-border interoperability of health data, and potential mechanisms of funding support to ensure equal development of data systems across the Union in respect of the primary and secondary use of electronic health data, a European Health Data Space Board (EHDS Board) should be set up. The Commission should participate in its activities and chair it. The EHDS Board should contribute to the consistent application of this Regulation throughout the Union, including by helping Member State to coordinate the use of electronic health data for healthcare, certification, but also concerning the secondary use of electronic health data. Given that, at national level, digital health authorities dealing with the primary use of electronic health data may be different to the health data access bodies dealing with the secondary use of electronic health data, the functions are different and there is a need for distinct cooperation in each of these areas, the EHDS Board should be able to set up subgroups dealing with these two functions, as well as other subgroups, as needed. For an efficient working method, the digital health authorities and health data access bodies should create networks and links at national level with different other bodies and authorities, but also at Union level. Such bodies could comprise data protection authorities, cybersecurity, eID and standardisation bodies, as well as bodies and e…

RemovedRecital 65 a (new): (65a) An advisory forum should be set up to advise the EHDS Board in the fulfilment of its tasks by providing stakeholder input on matters pertaining to this Regulation. The advisory forum should be composed of representatives of patients, consumers, health professionals, industry, scientific researchers and academia. It should have a balanced composition and represent the views of different relevant stakeholders. Both commercial and non-commercial interests should be represented.

RemovedRecital 66 a (new): (66a) Any natural person should have the right to lodge a complaint with a digital health authority or with a health data access body, in particular in the Member State of his or her habitual residence, and the right to an effective judicial remedy in accordance with Article 47 of the Charter if the natural person considers that his or her rights under this Regulation have been infringed or where the digital health authority or health data access body does not act on a complaint, partially or wholly rejects or dismisses a complaint or does not act where such action is necessary to protect the rights of the natural person. The investigation following a complaint should be carried out, subject to judicial review, to the extent that is appropriate in the specific case. The digital health authority or health data access body should inform the natural person of the progress and the outcome of the complaint within a reasonable period. If the case requires further investigation or coordination with another digital health authority or health data access body, intermediate information should be given to the natural person. In order to facilitate the submission of complaints, each digital health authority and health data access body should take measures such as providing a complaint submission form which can also be completed electronically, without excluding the possibility of using other means of communication. Where the complaint concerns the rights of natural persons, the health da…

RemovedRecital 66 b (new): (66b) Where a natural person considers that his or her rights under this Regulation have been infringed, he or she should have the right to mandate a not-for-profit body, organisation or association which is constituted in accordance with the law of a Member State, has statutory objectives which are in the public interest and is active in the field of the protection of personal data, to lodge a complaint on his or her behalf.

RemovedRecital 66 c (new): (66c) Any natural or legal person has the right to bring an action for annulment of decisions of the EHDS Board before the Court of Justice under the conditions provided for in Article 263 TFEU. As addressees of such decisions, the digital health authorities or health data access bodies concerned which wish to challenge them have to bring an action within two months of being notified of them, in accordance with Article 263 TFEU. In accordance with Article 263 TFEU, a health data holder, a health data applicant, a health data user or a complainant can bring an action for annulment against the decisions of the EHDS Board which concern them within two months of their publication on the website of the EHDS Board. Without prejudice to this right under Article 263 TFEU, each natural or legal person should have an effective judicial remedy before the competent national court against a decision of a digital health authority or health data access body which produces legal effects concerning that person. Such a decision concerns in particular the exercise of investigative, corrective and authorisation powers by the health data access body or the dismissal or rejection of complaints. However, the right to an effective judicial remedy does not encompass measures taken by digital health authorities and health data access bodies which are not legally binding, such as opinions issued or advice provided. Proceedings against a digital health authority or health data access body should be brou…

RemovedRecital 66 d (new): (66d) Where a court seised of proceedings against a decision by a digital health authority or health data access body has reason to believe that proceedings concerning the same access to electronic health data by the same health data user, such as for the same purpose for processing for secondary use, are brought before a competent court in another Member State, it should contact that court in order to confirm the existence of such related proceedings. If related proceedings are pending before a court in another Member State, any court other than the court first seised should be able to stay its proceedings or be able to, on request of one of the parties, decline jurisdiction in favour of the court first seised if that court has jurisdiction over the proceedings in question and its law permits the consolidation of such related proceedings. Proceedings should be deemed to be related where they are so closely connected that it is expedient to hear and determine them together in order to avoid the risk of irreconcilable judgments resulting from separate proceedings.

RemovedRecital 66 e (new): (66e) For proceedings against a health data holder or health data user, the plaintiff should have the choice of bringing the action before the courts of the Member States where the health data holder or health data user has an establishment or where the natural person resides, unless the health data holder is a public authority of a Member State acting in the exercise of its public powers.

RemovedRecital 66 f (new): (66f) The digital health authority, health data access body, health data holder or health data user should compensate any damage which a person could suffer as a result of processing that infringes this Regulation. The digital health authority, health data access body, health data holder or health data user should be exempt from liability if it proves that it was not in any way responsible for the damage. The concept of damage should be broadly interpreted in the light of the case law of the Court of Justice in a manner which fully reflects the objectives of this Regulation. This is without prejudice to any claims for damage deriving from the violation of other rules in Union or national law. Processing that infringes this Regulation should also include processing that infringes delegated and implementing acts adopted in accordance with this Regulation and national law specifying rules related to this Regulation. Natural persons should receive full and effective compensation for the damage they have suffered. Where digital health authorities, health data access bodies, health data holders or health data users are involved in the same processing, each actor should be held liable for the entire extent of the damage. However, where they are joined to the same judicial proceedings, in accordance with Member State law, it should be possible to apportion compensation according to the responsibility of each digital health authority, health data access body, health data holder or hea…

RemovedRecital 66 g (new): (66g) Where specific rules on jurisdiction are contained in this Regulation, in particular as regards proceedings seeking a judicial remedy including compensation, against a digital health authority, health data access body, health data holder or health data user, general jurisdiction rules such as those of Regulation (EU) No 1215/2012 of the European Parliament and of the Council1a should not prejudice the application of such specific rules. / 1a Regulation (EU) No 1215/2012 of the European Parliament and of the Council of 12 December 2012 on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 351, 20.12.2012, p. 1).

RemovedRecital 66 h (new): (66h) In order to strengthen the enforcement of the rules of this Regulation, penalties including administrative fines should be imposed for any infringement of this Regulation, in addition to, or instead of, appropriate measures imposed by the digital health authority or health data access body pursuant to this Regulation. In the case of a minor infringement or if the fine likely to be imposed would constitute a disproportionate burden for a natural person, it should be possible to issue a reprimand instead of a fine. Due regard should however be given to the nature, gravity and duration of the infringement, the intentional character of the infringement, actions taken to mitigate the damage suffered, the degree of responsibility or any relevant previous infringements, the manner in which the infringement became known to the digital health authority or health data access body, compliance with measures ordered against the health data holder or health data user, adherence to a code of conduct and any other aggravating or mitigating factor. The imposition of penalties, including administrative fines, should be subject to appropriate procedural safeguards in accordance with the general principles of Union law and the Charter, including effective judicial protection and due process.

RemovedRecital 66 i (new): (66i) Member States should be able to lay down the rules on criminal penalties for infringements of this Regulation, including for infringements of national rules adopted pursuant to and within the limits of this Regulation. Such criminal penalties could also involve the deprivation of profits obtained through infringements of this Regulation. However, the imposition of criminal penalties for infringements of such national rules and of administrative penalties should not lead to a breach of the principle of ne bis in idem, as interpreted by the Court of Justice.

RemovedRecital 66 j (new): (66j) It is appropriate to lay down provisions enabling health data access bodies to apply administrative fines for certain infringements of this Regulation whereby certain infringements are to be regarded as serious infringements, such as the re-identification of natural persons, downloading personal health data outside of the secure processing environment and processing of data for prohibited uses or outside a data permit. This Regulation should indicate infringements and the upper limit and criteria for setting the related administrative fines, which should be determined by the competent health data access body in each individual case, taking into account all the relevant circumstances of the specific situation, with due regard in particular to the nature, gravity and duration of the infringement and of its consequences and the measures taken to ensure compliance with the obligations under this Regulation and to prevent or mitigate the consequences of the infringement. Where administrative fines are imposed on an undertaking, an undertaking should be understood to be an undertaking in accordance with Articles 101 and 102 TFEU for those purposes. Where administrative fines are imposed on persons that are not an undertaking, the health data access body should take account of the general level of income in the Member State as well as the economic situation of the person in considering the appropriate amount of the fine. The consistency mechanism could also be used to promote …

RemovedRecital 66 k (new): (66k) The legal systems of Denmark and Estonia do not provide for administrative fines as set out in this Regulation. It should be possible to apply the rules on administrative fines in a manner such that in Denmark the fine is imposed by competent national courts as a criminal penalty, and that in Estonia the fine is imposed by the supervisory authority in the framework of a misdemeanour procedure, provided that such an application of the rules in those Member States has an equivalent effect to administrative fines imposed by supervisory authorities. Therefore the competent national courts should take into account the recommendation by the health data access body initiating the fine. In any event, the fines imposed should be effective, proportionate and dissuasive.

RemovedRecital 66 l (new): (66 l) Where this Regulation does not harmonise administrative penalties or where necessary in other cases, for example in cases of serious infringements of this Regulation, Member States should implement a system which provides for effective, proportionate and dissuasive penalties. The nature of such penalties, criminal or administrative, should be determined by national law.

RemovedRecital 69 a (new): (69a) In accordance with Article 42 of Regulation (EU) 2018/1725, the Commission should, when preparing delegated acts or implementing acts, consult the European Data Protection Supervisor where there is an impact on the protection of individuals’ rights and freedoms with regard to the processing of personal data, and where such an act is of particular importance for the protection of individuals’ rights and freedoms with regard to the processing of personal data, the Commission can also consult the European Data Protection Board. The Commission should moreover consult the European Data Protection Board in the cases specified in Regulation (EU) 2016/679 and when relevant in the context of this Regulation.

RemovedRecital 70: (70) Member States should take all necessary measures to ensure that the provisions of this Regulation are implemented, including by laying down effective, proportionate and dissuasive penalties for their infringement. When deciding on the amount of the penalty for each individual case Member States should take into account the margins and criteria set out in this Regulation. Re-identification of natural persons should be considered a particularly serious breach of this Regulation. Member States should be able to consider criminalising re-identification by health data users so that it serves as a deterrent measure.

RemovedRecital 71: (71) In order to assess whether this Regulation reaches its objectives effectively and efficiently, is coherent and still relevant and provides added value at Union level the Commission should carry out an evaluation of this Regulation. The Commission should carry out a partial evaluation of this Regulation 5 years after its entry into force, and an overall evaluation 7 years after the entry into force of this Regulation. The Commission should submit reports on its main findings following each evaluation to the European Parliament and to the Council, the European Economic and Social Committee and the Committee of the Regions.

RemovedRecital 74: (74) The European Data Protection Supervisor and the European Data Protection Board were consulted in accordance with Article 42 of Regulation (EU) 2018/1725 and delivered Joint opinion 03/2022 on 12 July 2022.

RemovedRecital 76: (76) Given the need for technical preparation, this Regulation should apply from [24 months after entry into force],

RemovedArticle 1 – paragraph 2 – point a: (a) specifies the rights of natural persons in relation to the availability, sharing and control of their electronic health data;

RemovedArticle 1 – paragraph 3 – point a: (a) manufacturers and suppliers of EHR systems and wellness applications, and of products claiming interoperability with EHR systems, placed on the market and put into service in the Union and the users of such products;

RemovedArticle 1 – paragraph 4: 4. This Regulation shall be without prejudice to other Union legal acts regarding access to, sharing of or secondary use of electronic health data, or requirements related to the processing of data in relation to electronic health data, in particular Regulations (EU) 2016/679, (EU) 2018/1725, (EU) 2022/868 and […] [Data Act COM/2022/68 final] and Directive 2002/58/EC of the European Parliament and of the Council1a. / 1a Directive 2002/58/EC of the European Parliament and of the Council of 12 July 2002 concerning the processing of personal data and the protection of privacy in the electronic communications sector (Directive on privacy and electronic communications) (OJ L 201, 31.7.2002, p. 37).

RemovedArticle 1 – paragraph 4 a (new): 4a. References to the provisions of Regulation (EU) 2016/679 shall be understood also as references to the corresponding provisions of Regulation (EU) 2018/1725 for Union institutions and bodies, where relevant.

RemovedArticle 1 – paragraph 5 a (new): 5a. This Regulation shall be without prejudice to Regulation (EU) No 536/2014 and Directive (EU) 2016/9431a. / 1a Directive (EU) 2016/943 of the European Parliament and of the Council of 8 June 2016 on the protection of undisclosed know-how and business information (trade secrets) against their unlawful acquisition, use and disclosure (OJ L 157, 15.6.2016, p. 1).

RemovedArticle 2 – paragraph 1 – point c: (c) the definitions of ‘data’, ‘access’, ‘data altruism’, ‘public sector body’ and ‘secure processing environment’, pursuant to Article 2, points (1), (8), (10), (11) and (14) of Regulation (EU) 2022/868;

RemovedArticle 2 – paragraph 2 – point a: (a) ‘personal electronic health data’ means data concerning health and genetic data as defined in Regulation (EU) 2016/679, that are processed in an electronic form;

RemovedArticle 2 – paragraph 2 – point b: (b) ‘non-personal electronic health data’ means data concerning health and aggregated genetic data in electronic format that falls outside the definition of personal data provided in Article 4, point (1), of Regulation (EU) 2016/679; where personal and non-personal data in a data set are inextricably linked, the entire dataset shall be processed as personal electronic health data;

RemovedArticle 2 – paragraph 2 – point d: (d) ‘primary use of electronic health data’ means the processing of electronic health data for the provision of health services to assess, maintain or restore the state of health of the natural person to whom that data relates, including the prescription, dispensation and provision of medicinal products and medical devices, as well as for relevant social security, administrative or reimbursement services;

RemovedArticle 2 – paragraph 2 – point e: (e) ‘secondary use of electronic health data’ means the processing of electronic health data for purposes set out in Chapter IV of this Regulation. The data used may include personal electronic health data initially collected in the context of primary use, but also electronic health data collected for the purpose of Chapter IV of this Regulation;

RemovedArticle 2 – paragraph 2 – point j: (j) ‘health professional access service’ means a service, supported by an EHR system, that enables health professionals to access data of natural persons under their care;

RemovedArticle 2 – paragraph 2 – point k: (k) ‘health data recipient’ means a recipient as defined in Article 4, point (9), of Regulation (EU) 2016/679, in the context of the primary use of electronic health data;

RemovedArticle 2 – paragraph 2 – point l: (l) ‘telemedicine’ means the provision of healthcare services, including remote care through the use of information and communication technologies, in situations where the health professional and the patient (or several health professionals) are not in the same location;

RemovedArticle 2 – paragraph 2 – point m: (m) ‘EHR’ (electronic health record) means a collection of electronic health data related to a natural person and collected in the health system, processed for the purpose of the provision of healthcare services;

RemovedArticle 2 – paragraph 2 – point n: (n) ‘EHR system’ (electronic health record system) means any product (hardware or software) primarily intended by the manufacturer to be used for storing, intermediating, importing, exporting, converting, editing or viewing electronic health records between health professionals or that can be reasonably expected by the manufacturer to be used for those purposes;

RemovedArticle 2 – paragraph 2 – point o: deleted

RemovedArticle 2 – paragraph 2 – point q – introductory part: (q) ‘serious incident’ means any malfunction or deterioration in the characteristics or performance of an EHR system made available on the market that directly or indirectly leads, has led or is likely to lead to any of the following:

RemovedArticle 2 – paragraph 2 – point q – point i: (i) the death of a natural person or serious damage to a natural person’s health or rights;

RemovedArticle 2 – paragraph 2 – point y: (y) ‘health data holder’ means any natural or legal person, which is an entity or a body in the health, social security or care sector or in the reimbursement services sector, or performs research in relation to these sectors, as well as Union institutions, bodies, offices and agencies, and which, in accordance with this Regulation, applicable Union law or national legislation implementing Union law: / (i) is a controller as set out in Regulation (EU) 2016/679 and has the right or obligation, in accordance with this Regulation, applicable Union law or national legislation implementing Union law, to process personal electronic health data; or / (ii) has the ability to make available, including to register, provide, restrict access or exchange non-personal electronic health data, through control of the technical design of a product and related services;

RemovedArticle 2 – paragraph 2 – point z: (z) ‘health data user’ means a natural or legal person, as well as a Union institution, body, office or agency, which has been granted lawful access, in accordance with this Regulation, to electronic health data for secondary use pursuant to a data permit or a health data request;

RemovedArticle 2 – paragraph 2 – point z a (new): (za) ‘health data applicant’ means any natural or legal person with a demonstrable professional link to the areas of health care, public health or medical research and that submits an application for health data;

RemovedArticle 2 – paragraph 2 – point aa: (aa) ‘health data permit’ means an administrative decision issued to a data user by a health data access body or data holder to process the electronic health data specified in the data permit for the secondary use purposes specified in the data permit based on conditions laid down in this Regulation;

RemovedArticle 2 – paragraph 2 – point a ea (new): (aea) ‘wellness application’ means any appliance or software intended by the manufacturer to be used by a natural person for processing electronic health data specifically for providing information on, managing, maintaining or improving the health of individual persons, or the delivery of care.

RemovedArticle 3 – paragraph 2: 2. Natural persons shall have the right to receive an electronic copy, in the European electronic health record exchange format referred to in Article 6, of at least their electronic health data, or at the request of the natural person, a printed copy thereof, in accordance with Article 15(3) of Regulation (EU) 2016/679.

RemovedArticle 3 – paragraph 2 a (new): 2a. The rights referred to in paragraphs 1 and 2 shall be deemed complementary to and be without prejudice to the rights and obligations established by Article 15 of Regulation (EU) 2016/679.

RemovedArticle 3 – paragraph 3: 3. In accordance with Article 23(1) , point (i), of Regulation (EU) 2016/679, Member States may restrict the scope of rights referred to in this Article whenever necessary for the protection of the natural person based on patient safety and ethics by delaying their access to their personal electronic health data for a limited period of time until a health professional can properly communicate and explain to the natural person information that can have a significant impact on him or her.

RemovedArticle 3 – paragraph 4: deleted

RemovedArticle 3 – paragraph 5 – subparagraph 1 – point a: (a) establish one or more electronic health data access services at national, regional or local level enabling the exercise of rights referred to in this Article;

RemovedArticle 3 – paragraph 5 – subparagraph 1 – point b: (b) establish one or more proxy services enabling a natural person to legally authorise other natural persons of their choice to access their electronic health data on their behalf for a specified or indeterminate period and if needed, for a specific purpose only, or enabling legal representatives of patients to access electronic health data of the natural persons whose affairs they administer, in accordance with national law.

RemovedArticle 3 – paragraph 5 – subparagraph 2: The proxy services shall provide authorisations in a transparent and easily understandable way, free of charge, electronically or on paper. Natural persons and those acting on their behalf shall be informed about their authorisation rights, how to exercise them, and what they can expect from the authorisation process. / The electronic health data access services as well as the proxy services shall be easily accessible for persons with disabilities, vulnerable groups or persons with low digital literacy. / The proxy services shall enable legal representatives of patients to be authorised, either automatically or upon request, to access electronic health data of the natural persons whose affairs they administer either for a specific purpose and time period or without limitation for the purpose of such administration. Member States may provide that authorisations do not apply whenever necessary for reasons related to the protection of the natural person, and in particular based on patient safety and ethics. The proxy services shall be interoperable among Member States. / The proxy services shall provide an easy complaint mechanism with a contact point designated to inform individuals of a way to seek redress or remedy if they believe that their authorisation rights have been violated.

RemovedArticle 3 – paragraph 5 a (new): 5a. In addition to the electronic services referred to in this Article, Member States shall also establish easily accessible support services for natural persons with adequately trained staff dedicated to assisting them with exercising their rights referred to in this Article.

RemovedArticle 3 – paragraph 6: 6. Natural persons may insert their electronic health data in their own EHR or in that of natural persons whose health information they can access, through electronic health data access services and applications linked to these services. That information shall be marked as inserted by the natural person or by their legal representative and as non-validated. That information shall only be considered as a clinical fact if validated by a health professional. Without prejudice to the right to insert data, health professionals shall not be obliged to validate any inserted data in the EHR.

RemovedArticle 3 – paragraph 6 a (new): 6a. Natural persons shall have the right to download their electronic health data from their own EHR or the data of natural persons whose health information they can access through electronic health data access services and applications linked to these services.

RemovedArticle 3 – paragraph 7: 7. Member States shall ensure that electronic health data services referred to in paragraph 5, point (a), of this Article allow for the possibility for natural persons to easily request rectification of their personal data online as a way to exercise their right to rectification under Article 16 of Regulation (EU) 2016/679. Natural persons shall not have the possibility of directly changing data inserted by health professionals. Such rectifications of clinical facts shall be validated, without undue delay, by a registered healthcare professional with a relevant specialisation who is responsible for the natural person’s treatment. The original data holder shall be responsible for the rectification.

RemovedArticle 3 – paragraph 8 – subparagraph 1: Natural persons shall have the right to request a health data holder from the health or social security sector or reimbursement services, to transmit all or part of their electronic health data to a health data recipient of their choice from the health or social security sector or reimbursement services, immediately, free of charge and without hindrance from the data holder or from the manufacturers of the systems used by that holder. The health data recipient shall be clearly identified by the natural persons to the health data holder and their affiliation to the health or social security sector shall be demonstrated. Health data holders and their processors shall comply with the request and shall transmit the data in the format provided for in Article 5.

RemovedArticle 3 – paragraph 8 – subparagraph 2: Natural persons shall have the right that, where the health data holder and the health data recipient are located in different Member States and such electronic health data belongs to the categories referred to in Article 5, the health data holder shall transmit the data in the European electronic health record exchange format referred to in Article 6 and the health data recipient shall read and accept it.

RemovedArticle 3 – paragraph 8 – subparagraph 3: By way of derogation from Article 9 of Regulation […] [Data Act COM/2022/68 final], the health data recipient shall not be required to compensate the health data holder for making electronic health data available. A health data holder, a health data recipient or a third party shall not directly or indirectly charge data subjects a fee, compensation or costs for sharing data or accessing it.

RemovedArticle 3 – paragraph 9: 9. Without prejudice to Article 6(1), point (d), of Regulation (EU) 2016/679, natural persons shall have the right to restrict access of specific health professionals or categories of health professionals to all or part of their electronic health data. When restricting the information, natural persons shall be made aware that restricting access may impact the provision of healthcare provided to them. Such restrictions shall apply also for cross-border transfers of electronic health data. The fact that a restriction has been made by the natural person shall not be visible to healthcare providers. / Member States shall establish the rules and specific safeguards regarding such restriction mechanisms. Those rules shall include the possibility of modifying restrictions and of restricting access to anyone except the health professional who inserted the electronic health data. Those rules shall also establish the conditions of medical liability as a consequence of applying restrictions to electronic health data. The Commission shall establish guidelines regarding the implementation of this paragraph.

RemovedArticle 3 – paragraph 10: 10. Natural persons shall have the right to obtain information, including through automatic notifications, on the healthcare providers and health professionals that have accessed their electronic health data, including access provided in accordance with Article 4(4), and on the substance of the accessed data. Natural persons shall have the possibility of disabling those notifications. In order to demonstrate compliance with this right, all relevant entities shall maintain a system of automated recording for at least three years showing who and when has accessed electronic health data. The information shall be provided immediately and free of charge through electronic health data access services. Member States may provide for restrictions to this right in exceptional circumstances, where there are factual indications that disclosure would endanger the vital interests or rights of the health professional or the care of the natural person.

RemovedArticle 3 – paragraph 11: 11. The supervisory authority or authorities responsible for monitoring the application of Regulation (EU) 2016/679 shall also be responsible for monitoring the application of this Article, in accordance with the relevant provisions in Chapters VI, VII and VIII of Regulation (EU) 2016/679.

RemovedArticle 3 – paragraph 12: 12. The Commission shall, by means of implementing acts, determine the requirements concerning the technical implementation of the rights set out in this Article, including technical and organisational measures to ensure the process of authentication of the authorised person referred to in paragraph 5, point (b), of this Article. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 68(2a).

RemovedArticle 3 – paragraph 12 a (new): 12a. Member States, including regional and local authorities, shall provide easily understandable information to natural persons in relation to the use of the electronic health records and primary use of their personal electronic health data laid down in this Article. Such guidance shall take into account different user groups, including persons with disabilities and vulnerable groups, without compromising the quality and the scope of the information.

RemovedArticle 4 – paragraph -1 (new): -1. Access to EHR for primary use shall be strictly limited to healthcare providers.

RemovedArticle 4 – paragraph 1 – point a: (a) have access, based on the data minimisation and purpose limitation principles, to the electronic health data of natural persons under their treatment and exclusively for the purpose of that treatment, including relevant administration, irrespective of the Member State of affiliation and the Member State of treatment, in accordance with Article 9(2), point (h), of Regulation 2016/679;

RemovedArticle 4 – paragraph 2: 2. In line with the data minimisation and purpose limitation principles provided for in Regulation (EU) 2016/679, Member States shall establish rules providing for the categories of personal electronic health data required by different categories of health professions or different healthcare tasks. Such rules shall not be based on the source of electronic health data.

RemovedArticle 4 – paragraph 2 a (new): 2a. In the case of treatment in a Member State other than the Member State of affiliation, the rules referred to in paragraphs 1a and 2 of the Member States of treatment shall apply.

RemovedArticle 4 – paragraph 2 b (new): 2b. The Commission shall issue guidelines for the implementation of paragraphs 1, 2 and 2a, including time limitations for the access by health professionals to electronic health data of natural persons.

RemovedArticle 4 – paragraph 3: 3. Member States and, where appropriate, local or regional authorities shall ensure that access to at least the priority categories of electronic health data referred to in Article 5 is made available to health professionals, including for cross-border care, through health professional access services, where the processing of health data is necessary and for the purposes of Article 9(2), point (h), of Regulation 2016/679. Health professionals who are in possession of recognised electronic identification means shall have the right to use those health professional access services, free of charge. / The electronic health data in the electronic health records shall be structured in a user-friendly manner to allow for easy use by health professionals.

RemovedArticle 4 – paragraph 3 a (new): 3a. Member States shall establish policies aimed at providing health professionals with the digital skills, competences, infrastructures and tools required to fulfil the obligations set out in paragraph 1.

RemovedArticle 4 – paragraph 4: 4. Where access to electronic health data has been restricted by the natural person, the healthcare provider or health professionals shall not be informed of the restricted content of the electronic health data without prior explicit consent pursuant to Article 9(2), point (a), of Regulation (EU) 2016/679 by the natural person. In cases where processing is necessary in order to protect the vital interests of the data subject or of another natural person, the healthcare provider or health professional may get access to the restricted electronic health data. Following such access, the healthcare provider or health professional shall inform the data holder and the natural person concerned or his/her guardians that access to electronic health data had been granted. Member States’ law may add additional safeguards.

RemovedArticle 5 – paragraph 1 – subparagraph 1 – introductory part: 1. Where data is processed in electronic format, Member States shall implement access to and exchange of personal electronic health data for primary use fully or partially falling under the following categories making use of the International Classification of Diseases (ICD) codes, where applicable:

RemovedArticle 5 – paragraph 1 – subparagraph 1 – point e: (e) laboratory results, medical test results and other complementary and diagnostic results;

RemovedArticle 5 – paragraph 1 – subparagraph 1 – point f: (f) patient discharge reports;

RemovedArticle 5 – paragraph 1 – subparagraph 1 – point f a (new): (fa) medical directives of the natural persons and information about consent for substances of human origin and organ donations.

RemovedArticle 5 – paragraph 1 – subparagraph 2: The main characteristics of the categories of electronic health data in the first subparagraph shall be as set out in Annex I and limited to those categories.

RemovedArticle 5 – paragraph 1 – subparagraph 3: Member States may provide for access to and exchange of electronic health data for primary use for other categories of personal electronic health data available in the EHR of natural persons.

RemovedArticle 5 – paragraph 2: 2. The Commission is empowered to adopt delegated acts in accordance with Article 67 to amend Annex I by adding, modifying or removing the main characteristics of the priority categories of electronic health data, as laid down in paragraph 1. / (deleted) / (deleted) / (deleted)

RemovedArticle 6 – paragraph 1 – introductory part: 1. The Commission shall, by means of implementing acts, lay down the technical specifications for the priority categories of personal electronic health data referred to in Article 5, setting out the European electronic health record exchange format, taking into account its Recommendation (EU) 2019/243. The format shall include the following elements:

RemovedArticle 6 – paragraph 1 – point a: (a) harmonised datasets containing electronic health data and defining structures, such as minimum data fields and data groups for the content representation of clinical content and other parts of the electronic health data, which can be enlarged to include disease-specific data;

RemovedArticle 6 – paragraph 1 – point c: (c) technical interoperability specifications for the exchange of electronic health data, including its content representation, standards and profiles, and for the translation of electronic health data.

RemovedArticle 6 – paragraph 1 – subparagraph 1 (new): The Commission shall ensure that those implementing acts contain the latest versions of healthcare coding systems and nomenclatures and that they are updated regularly in order to keep up with the revisions of the healthcare coding systems and nomenclatures.

RemovedArticle 6 – paragraph 2: 2. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 68(2a).

RemovedArticle 6 – paragraph 3: 3. Member States shall ensure that the priority categories of personal electronic health data referred to in Article 5 are issued in the format referred to in paragraph 1 across the continuum of care and such data shall be read and accepted by the data recipient.

RemovedArticle 7 – paragraph 1: 1. Member States shall ensure that, where health data is processed, health professionals register the relevant health data falling under at least the priority categories referred to in Article 5 concerning the health services provided by them to natural persons, in the electronic format in an EHR system.

RemovedArticle 7 – paragraph 1 a (new): 1a. Member States may provide for natural persons to have the right to object to the registration of their personal health data in an EHR system. / If a Member State provides for such a right, it shall establish the rules and specific safeguards regarding such objection mechanisms.

RemovedArticle 7 – paragraph 3 – subparagraph 1: 3. The Commission shall adopt delegated acts in accordance with Article 67 to supplement this Regulation by determining the data quality requirements for the electronic registration of health data by healthcare providers and natural persons, as relevant. / (deleted) / (deleted) / (deleted)

RemovedArticle 7 – paragraph 3 – subparagraph 2: When health data are registered or updated, electronic health records shall identify the health professional, time and health care provider that carried out the registration or the update. Member States may provide for other aspects of data registration to be recorded.

RemovedArticle 7 – paragraph 3 a (new): 3a. Where the personal health data have not been registered electronically prior to the application of this Regulation, Member States may require that such data be made available in electronic format pursuant to this Article. This shall not affect the obligation to make personal electronic health data, registered after the application of this Regulation, available in electronic format, pursuant to this Article.

RemovedArticle 8 – paragraph 1: Where a Member State accepts the provision of telemedicine services, it shall, under the same conditions and in a non-discriminatory manner, accept the provision of the services of the same type by healthcare providers located in other Member States, without prejudice to the same rights and obligations to access and register electronic health data.

RemovedArticle 9 – paragraph 1: 1. Where a natural person or a health professional uses, telemedicine services or personal health data access services referred to in Article 3(5), point (a), Article 4(3) and where applicable, Article 8 that natural person or health professional shall have the right to identify electronically using any electronic identification means which is recognised pursuant to Article 6 of Regulation (EU) No 910/2014, including eID schemes where such systems are offered.

RemovedArticle 9 – paragraph 2: 2. The Commission shall adopt delegated acts in accordance with Article 67 to supplement this Regulation by determining the requirements for the interoperable, cross-border identification and authentication mechanism for natural persons and health professionals, in accordance with Regulation (EU) No 910/2014. The mechanism shall facilitate the transferability of electronic health data in a cross-border context.

RemovedArticle 9 – paragraph 3: 3. The Commission, in cooperation with Member States, shall implement services required by the interoperable, cross-border identification and authentication mechanism referred to in paragraph 2 of this Article at Union level, as part of the cross-border digital health infrastructure referred to in Article 12(3).

RemovedArticle 9 – paragraph 4: 4. Member States’ competent authorities and the Commission shall implement the cross-border identification and authentication mechanism at Union and Member States’ level, respectively, in accordance with Regulation (EU) No 910/2014.

RemovedArticle 10 – paragraph 2 – introductory part: 2. Each digital health authority shall be entrusted with the following tasks and powers:

RemovedArticle 10 – paragraph 2 – point b: (b) ensure that complete and up to date information about the implementation of rights and obligations provided for in in Chapters II and III is made readily available to natural persons, health professionals and healthcare providers and that appropriate training initiatives are undertaken at the local, regional and national level;

RemovedArticle 10 – paragraph 2 – point h: (h) contribute, at Union level, and, where relevant, in cooperation at local and regional level within the Member States, to the development of the European electronic health record exchange format and to the elaboration of common specifications addressing quality, interoperability, security, safety, ease of use, accessibility, non-discrimination or fundamental right concerns in accordance with Article 23 and of the specifications of the EU database for EHR systems and wellness applications referred to in Article 32;

RemovedArticle 10 – paragraph 2 – point k: (k) offer, in compliance with national legislation, telemedicine services and ensure that such services are easy to use, accessible and equitable to different groups of natural persons and health professionals, including natural persons with disabilities, under the same non-discriminatory conditions and offer the possibility of choosing between in person and digital services;

RemovedArticle 10 – paragraph 2 – point m: (m) cooperate with other relevant entities and bodies at local, regional, national or Union level, to ensure interoperability, data portability and security of electronic health data;

RemovedArticle 10 – paragraph 3: deleted

RemovedArticle 10 – paragraph 3 a (new): 3a. The digital health authorities and the data protection authorities shall consult each other and cooperate in the enforcement of this Regulation, within the remit of their respective competences.

RemovedArticle 10 – paragraph 5: 5. Members of the digital health authority shall avoid any conflicts of interest. Members shall not have financial or other interests in industries or economic activities which could affect their impartiality. They shall undertake to act in the public interest and in an independent manner, and shall make an annual declaration of their financial interests. All indirect interests which could relate to such industries or economic activities shall be entered in a register available to the public, upon request. The Commission may adopt guidance on what is likely to constitute a conflict of interest together with the procedure to be followed in such cases.

RemovedArticle 10 – paragraph 5 a (new): 5a. In the performance of their tasks, the digital health authorities shall actively cooperate and consult with relevant stakeholders’ representatives, including patients’ representatives, health care providers and health professionals’ representatives, including health professional associations, consumer organisations and industry associations. Stakeholders shall declare any conflict of interest.

RemovedArticle 11 – paragraph 1: 1. Without prejudice to any other administrative or judicial remedy, natural and legal persons shall have the right to lodge a complaint, individually or, where relevant, collectively, with the digital health authority, where their rights laid down in this Regulation are affected. Where the complaint concerns the rights of natural persons pursuant to Article 3 of this Regulation or Regulation (EU) 2016/679, the digital health authority shall send a copy of the complaint to and consult with the competent supervisory authority under Regulation (EU) 2016/679 in order to facilitate its assessment and investigation. The decision of the digital health authority shall not prejudice any measures taken by the data protection authorities, which shall be competent to treat the complaint in separate proceedings, pursuant to their tasks and powers under Regulation (EU) 2016/679.

RemovedArticle 11 – paragraph 2: 2. The digital health authority with which the complaint has been lodged shall inform the complainant of the progress of the proceedings and of the decision taken, including, where applicable, that the complaint was referred to the relevant supervisory authority under Regulation (EU) 2016/679, and that the supervisory authority will, from that moment on, be the sole point of contact for the complainant in that matter.

RemovedArticle 11 – paragraph 3 a (new): 3a. Each digital health authority shall facilitate submitting complaints, in particular by providing a complaint submission form which can also be completed electronically, without excluding the possibility of using other means of communication.

RemovedArticle 11 a (new): Article 11a / Right to an effective judicial remedy against a digital health authority / 1. Without prejudice to any other administrative or non-judicial remedy, each natural or legal person shall have the right to an effective judicial remedy against a legally binding decision of a digital health authority concerning them. / 2. Without prejudice to any other administrative or non-judicial remedy, each natural or legal person shall have the right to an effective judicial remedy where the digital health authority which is competent pursuant to Article 10 does not handle a complaint or does not inform the natural or legal person within three months about the progress or outcome of the complaint lodged pursuant to Article 11. / 3. Proceedings against a digital health authority shall be brought before the courts of the Member States where the digital health authority is established.

RemovedArticle 12 – paragraph 4: 4. The Commission shall, by means of implementing acts, adopt the necessary measures for the technical development of MyHealth@EU, detailed rules concerning the security, confidentiality and protection of electronic health data and the conditions and compliance checks necessary to join and remain connected to MyHealth@EU and conditions for temporary or definitive exclusion from MyHealth@EU. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 68(2a). The implementing act shall include the target implementation dates, including for cross border health data interoperability, in consultation with the EHDS board. The European Union Agency for Cyber Security (ENISA) shall be consulted and closely involved in all steps of the examination procedure. Any measures adopted shall meet the highest technical standards in terms of security, confidentiality and protection of electronic health data.

RemovedArticle 12 – paragraph 6: 6. Member States shall ensure that pharmacies operating on their territories, including online pharmacies, are enabled to dispense electronic prescriptions issued by other Member States, under the conditions laid down in Article 11 of Directive 2011/24/EU. The pharmacies shall access and accept electronic prescriptions transmitted to them from other Member States through MyHealth@EU, provided that the requirements in Article 11 of Directive 2011/24/EU are fulfilled. Following dispensation of medicinal products based on an electronic prescription from another Member State, pharmacies shall report the dispensation to the Member State that issued the prescription, through MyHealth@EU.

RemovedArticle 12 – paragraph 8: 8. The Commission shall, by means of implementing acts, allocate responsibilities among controllers and as regards the processor referred to in paragraph 7 of this Article, in accordance with Chapter IV of Regulations (EU) 2016/679 and 2018/1725. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 13 – paragraph 3: deleted / (deleted) / (deleted)

RemovedArticle 14 – paragraph 2: 2. This Chapter shall not apply to general software used in a healthcare environment that it is not interoperable with EHR systems.

RemovedArticle 14 – paragraph 4: 4. Notwithstanding the obligations laid down in Regulation [AI act COM/2021/206 final], providers of high-risk AI systems as defined in Article 6 of Regulation […] [AI act COM/2021/206 final], which do not fall within the scope of Regulation (EU) 2017/745, that claim interoperability of those AI systems with EHR systems will need to prove compliance with the essential requirements on interoperability laid down in Section 2 of Annex II of this Regulation. Article 23 of this Chapter shall be applicable to those high-risk AI systems.

RemovedArticle 15 – paragraph 1: 1. EHR systems may be placed on the market or put into service only if they comply with the provisions laid down in Section 3 of this Chapter and in Annex II.

RemovedArticle 16 – paragraph 1 – introductory part: In the information sheet, instructions for use or other information accompanying EHR systems, and in the advertising of EHR systems, it shall be prohibited to use text, names, trademarks, pictures and figurative or other signs that may mislead the professional user as defined under Regulation (EU) 2018/1807 with regard to its intended purpose, interoperability and security by:

RemovedArticle 16 – paragraph 1 – point b: (b) failing to inform the professional user of likely limitations related to interoperability or security features of the EHR system in relation to its intended purpose;

RemovedArticle 17 – paragraph 1 – point a: (a) obtain for their EHR systems a certificate of compliance from an independent third-party body to attest their conformity with the essential requirements laid down in Annex II and with the common specifications in accordance with Article 23;

RemovedArticle 17 – paragraph 1 – point b: (b) draw up the technical documentation of their EHR systems in accordance with Article 24 before placing their systems on the market, and subsequently keep them up to date;

RemovedArticle 17 – paragraph 1 – point c: (c) ensure that their EHR systems are accompanied, free of charge for the user, by the information sheet provided for in Article 25 and clear and complete instructions for use including in accessible formats for vulnerable groups and persons with disabilities;

RemovedArticle 17 – paragraph 1 – point d: (d) carry out the relevant conformity assessment procedures as referred to in Article 27a and Annex IVa;

RemovedArticle 17 – paragraph 1 – point d a (new): (da) draw up the EU declaration of conformity in accordance with Article 26;

RemovedArticle 17 – paragraph 1 – point e: (e) affix the CE marking in accordance with Article 27 after the conformity assessment procedure has been completed;

RemovedArticle 17 – paragraph 1 – point e a (new): (ea) indicate the name, registered trade name or registered trade mark, and the postal address and website, e-mail address or other digital contact at which they can be contacted, on the front office of the EHR system; the address shall indicate a single point at which the manufacturer can be contacted and. the contact details shall be in a language that is easily understood by users and market surveillance authorities;

RemovedArticle 17 – paragraph 1 – point g: (g) take any necessary corrective action in respect of their EHR systems immediately, where manufacturers consider or have reasons to believe that such systems are not or no longer in conformity with the essential requirements laid down in Annex II, or recall or withdraw such systems; the manufacturers shall then inform the national authorities of the Member States in which they made their EHR systems available or put them into service of the non-conformity and of any corrective action taken;

RemovedArticle 17 – paragraph 1 – point h: (h) immediately inform the distributors of their EHR systems and, where applicable, the authorised representative and importers of the non-conformity and of any corrective action, recall or withdrawal of that system;

RemovedArticle 17 – paragraph 1 – point i: deleted

RemovedArticle 17 – paragraph 1 – point j: (j) upon request provide market surveillance authorities in the Member States with all the information and documentation in paper or digital format, necessary to demonstrate the conformity of the EHR system which they have placed on the market or put into service with the essential requirements laid down in Annex II and Article 27a in the official language of the Member State.

RemovedArticle 17 – paragraph 1 – point k: (k) cooperate with market surveillance authorities, at their request, on any action taken to bring their EHR systems which they have placed on the market or put into service in conformity with the essential requirements laid down in Annex II and Article 27a in the official language of the Member State.

RemovedArticle 17 – paragraph 1 – point k a (new): (ka) establish channels of complaint and keep a register of complaints, of non-conforming EHR systems, and keep distributors informed of any such monitoring.

RemovedArticle 17 – paragraph 2: 2. Manufacturers of EHR systems shall ensure that procedures are in place to ensure that the design, development and deployment of an EHR system continues to comply with the essential requirements laid down in Annex II and the common specifications referred to in Article 23 for EHR systems to remain in conformity with this Regulation. Changes in EHR system design or characteristics and changes in the technical standards and the technical specifications referred to in Annex II and III by reference to which the conformity of the EHR system is declared shall be adequately taken into account and reflected in the technical documentation. / Manufacturers shall establish reporting channels and ensure their accessibility to allow users to submit complaints, and shall keep a register of complaints, of non-conforming EHR systems and EHR system recalls.

RemovedArticle 17 – paragraph 3: 3. Manufacturers of EHR systems shall keep the technical documentation and the EU declaration of conformity at the disposal of the market surveillance authorities for at least 10 years after the last EHR system covered by the EU declaration of conformity has been placed on the market. The source code or the programming logic included in the technical documentation shall, upon a reasoned request, be made available to the competent national authorities, if that source code or programming logic is necessary in order for them to be able to check compliance with the essential requirements set out in Annex II. The personnel of competent national authorities shall observe professional secrecy with regard to all information obtained in carrying out the conformity assessment activities in accordance with Annexes IVa, except in relation to the competent authorities of the Member State in which their activities are carried out. Proprietary rights, intellectual property rights and trade secrets shall be protected. Manufacturers shall establish reporting channels and ensure their accessibility to allow users to submit complaints, keep a register of complaints, of non-conforming EHR systems and EHR systems recalls.

RemovedArticle 17 – paragraph 3 a (new): 3a. A manufacturer of EHR systems established outside the Union shall ensure that its authorised representative has the necessary documentation readily available in order to fulfil the tasks referred to in Article 18(2).

RemovedArticle 17 – paragraph 3 b (new): 3b. Manufacturers shall, further to a reasoned request from a market surveillance authority, provide it with all the information and documentation, in paper or electronic form, necessary to demonstrate the conformity of the EHR system with the essential requirements set out in Annex II and the common specifications referred to in Article 23, in a language which can be easily understood by that authority. They shall cooperate with that authority, at its request, on any measures taken to eliminate the risks posed by the EHR system, which they have placed on the market or put into service.

RemovedArticle 17 – paragraph 3 c (new): 3c. Liability rules under Directive 85/374/EEC, shall apply to manufacturers of EHR systems without prejudice to more protective measures under national law.

RemovedArticle 18 – paragraph 2 – introductory part: 2. An authorised representative shall perform the tasks specified in the mandate agreed with the manufacturer. The mandate shall allow the authorised representative to do at least the following:

RemovedArticle 18 – paragraph 2 – point a: (a) keep the EU declaration of conformity and the technical documentation at the disposal of the Member State market surveillance authorities for the period referred to in Article 17(3);

RemovedArticle 18 – paragraph 2 – point b: (b) further to a reasoned request from a market surveillance provide authorities of the Member States concerned a copy of the mandate with all the information and documentation necessary to demonstrate the conformity of an EHR system with the essential requirements laid down in Annex II;

RemovedArticle 18 – paragraph 2 – point b a (new): (ba) immediately inform the manufacturer if the authorised representative has a reason to believe that an EHR system is no longer in conformity with the essential requirements laid down in Annex II;

RemovedArticle 18 – paragraph 2 – point b b (new): (bb) immediately inform the manufacturer about complaints received by consumers and professional users;

RemovedArticle 18 – paragraph 2 – point c: (c) cooperate with the market surveillance authorities in the Member State, at their request, on any corrective action taken in relation to the EHR systems covered by their mandate.

RemovedArticle 18 – paragraph 2 a (new): 2a. In the event of a change of the authorised representative, the detailed arrangements for the change shall address at least the following aspects: / (a) the date of termination of the mandate of the outgoing authorised representative and the date of the beginning of the mandate of the incoming authorised representative; / (b) the transfer of documents, including confidentiality aspects and property rights.

RemovedArticle 19 – paragraph 2 – point a: (a) the manufacturer has obtained a certificate of compliance from an independent third body to attest to the relevant conformity assessment procedure referred to in Article 27a and drawn up the EU declaration of conformity in accordance with Article 26; and drawn up the technical documentation, in accordance with Article 24, before placing their system on the market;

RemovedArticle 19 – paragraph 2 – point a a (new): (aa) the manufacturer is identified and an authorised representative in accordance with Article 18 has been appointed;

RemovedArticle 19 – paragraph 2 – point b: (b) the EHR system bears the CE marking of conformity referred to in Article 27 after the conformity assessment procedure has been completed;

RemovedArticle 19 – paragraph 2 – point c: (c) the EHR system is accompanied by the information sheet referred to in Article 25 with clear and complete instructions for use including in accessible formats.

RemovedArticle 19 – paragraph 3: 3. Importers shall indicate their name, registered trade name or registered trade mark and the postal address and website, e-mail address or other digital contact at which they can be contacted in a document accompanying the EHR system. The address shall indicate a single point at which the manufacturer can be contacted. The contact details shall be in a language easily understood by users and the market surveillance authorities. They shall ensure that any additional label does not obscure any information on the label provided by the manufacturer.

RemovedArticle 19 – paragraph 4: 4. Importers shall ensure that, while an EHR system is under their responsibility, the EHR system is not altered in such a way that its conformity with the essential requirements laid down in Annex II and Article 27a is jeopardised.

RemovedArticle 19 – paragraph 5: 5. Where an importer considers or has reason to believe that an EHR system is not or no longer in conformity with the essential requirements in Annex II and Article 27a, it shall not make that system available on the market, or shall recall it or withdraw it if was already available on the market, until that system has been brought into conformity. The importer shall inform immediately the manufacturer of such EHR system and the market surveillance authorities of the Member State in which it made the EHR system available, to that effect, giving details, in particular, of the non-conformity and of any corrective measures, recall or withdrawal of that system taken. Where an importer considers or has reason to believe that an EHR system presents a risk to the health or safety of natural persons, it shall immediately inform the market surveillance authority of the Member State in which the importer is established, as well as the manufacturer and where applicable, the authorised representative.

RemovedArticle 19 – paragraph 7: 7. Importers shall, further to a reasoned request from a market surveillance authorities of Member States concerned provide it with all the information and documentation in paper or digital format necessary to demonstrate the conformity of an EHR system. They shall cooperate with that authority, at its request, and with the manufacturer and, where applicable, with the manufacturer’s authorised representative on any action taken to bring their EHR systems in conformity with the essential requirements laid down in Annex II, and Article 27a, or to ensure that their EHR systems are withdrawn or recalled.

RemovedArticle 19 – paragraph 7 a (new): 7a. Manufacturers shall establish reporting channels and ensure their accessibility to allow users to submit complaints, keep a register of complaints, of non-conforming EHR systems and EHR systems recalls. Importers shall verify whether the established channels of complaint referred to in Article 17(2) are publicly available allowing them to submit complaints and communicate any risk related to their health and safety or to other aspects of public interest protection and of any serious incident involving an EHR system. If such channels are not available, the importer shall provide for them, taking into account the accessibility needs of vulnerable groups and persons with disabilities.

RemovedArticle 19 – paragraph 7 b (new): 7b. Importers shall investigate complaints and information on incidents involving an EHR system they made available on the market and file those complaints, as well as of system recalls and any corrective measures taken to bring the EHR system into conformity, in the register referred to in Article 17(3d) or in their own internal register. Importers shall keep the manufacturer, distributors and, where relevant, authorised representatives informed in a timely manner of the investigation performed and of the results of the investigation.

RemovedArticle 20 – paragraph 1 – point a: (a) the manufacturer has obtained a certificate of compliance from an independent third body to attest to the relevant conformity assessment procedure referred to in Article 27a and has drawn up the EU declaration of conformity, in accordance with Article 26, and the technical documentation, in accordance with Article 24, before placing their system on the market;

RemovedArticle 20 – paragraph 1 – point b: (b) the EHR system bears the CE marking of conformity referred to in Article 27 after the conformity assessment procedure has been completed;

RemovedArticle 20 – paragraph 1 – point c: (c) the EHR system is accompanied by the information sheet referred to in Article 25 with clear and complete instructions for use in accessible formats;

RemovedArticle 20 – paragraph 2: 2. Distributors shall ensure that, while an EHR system is under their responsibility, the EHR system is not altered in such a way that its conformity with the essential requirements laid down in Annex II and Article 27a is jeopardised.

RemovedArticle 20 – paragraph 3: 3. Where a distributor considers or has reason to believe that an EHR system is not in conformity with the essential requirements laid down in Annex II and Article 27a, it shall not make the EHR system available on the market, or shall recall it or withdraw it if was already available on the market, until it has been brought into conformity. Furthermore, the distributor shall inform immediately the manufacturer or the importer, as well as the market surveillance authorities of the Member states where the EHR system has been made available on the market, to that effect. Where a distributor considers or has reason to believe that an EHR system presents a risk to the health or safety of natural persons, it shall immediately inform the market surveillance authority of the Member State in which the distributor is established, as well as the manufacturer, the importer and where applicable, the authorised representative.

RemovedArticle 20 – paragraph 4: 4. Distributors shall, further to a reasoned request from a market surveillance authority, provide it with all the information and documentation necessary to demonstrate the conformity of an EHR system. They shall cooperate with that authority, at its request, and with the manufacturer, the importer and, where applicable, with the manufacturer’s authorised representative on any action taken to bring the EHR systems in conformity with the essential requirements laid down in Annex II or to withdraw or recall it.

RemovedArticle 21 – title: Cases in which obligations of manufacturers of an EHR system apply to economic operators

RemovedArticle 21 – paragraph 1: If any economic operator other than the manufacturer makes modifications to the EHR system whilst deploying or using it, which lead to changes in the intended purpose and deployment recommendations for the EHR system as declared by the manufacturer, in any case of any malfunctioning or deterioration in performance quality due to the changes made by the economic operator during deployment or use of the EHR system contrary to the manufacturer’s recommendations for technical deployment of the system or purpose of its use, the economic operator shall be considered a manufacturer for the purposes of this Regulation and shall be subject to the obligations laid down in Article 17.

RemovedChapter III – Section 3 – title: Conformity Assessment

RemovedArticle 23 – paragraph 1 – subparagraph 1: 1. The Commission shall, by means of implementing acts, adopt common specifications in respect of the essential requirements set out in Annex II, including a common template document and a time limit for implementing those common specifications. Where relevant, the common specifications shall take into account the specificities and verify compatibility with sectoral legislation and harmonised standards of medical devices and high risk AI systems referred to in paragraphs 3 and 4 of Article 14, including the state-of-the art standards for health informatics and the European electronic health record exchange format.

RemovedArticle 23 – paragraph 1 – subparagraph 2: 2. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2) after consultation with the EHDS board and the Advisory Forum.

RemovedArticle 23 – paragraph 4 a (new): 4a. Where common specifications have an impact on data protection requirements for EHR systems, they shall be subject to consultation with the European Data Protection Board (EDPB) and the European Data Protection Supervisor (EDPS) before their adoption, pursuant to Article 42(2) of Regulation (EU) 2018/1725.

RemovedArticle 23 – paragraph 5: 5. Where common specifications covering interoperability and security requirements of EHR systems affect medical devices or high-risk AI systems falling under other acts, such as Regulations (EU) 2017/745 or […] [AI Act COM/2021/206 final], the adoption of those common specifications shall be preceded by a consultation with the Medical Devices Coordination Group (MDCG) referred to in Article 103 of Regulation (EU) 2017/745 or the European Artificial Intelligence Board referred to in Article 56 of Regulation […] [AI Act COM/2021/206 final], as applicable, as well as the EDPB referred to in Article 68 of Regulation (EU) 2016/679.

RemovedArticle 23 – paragraph 6: 6. Where common specifications covering interoperability and security requirements of medical devices or high-risk AI systems falling under other acts such as Regulation (EU) 2017/745 or Regulation […] [AI Act COM/2021/206 final], impact EHR systems, the adoption of those common specifications shall be preceded by a consultation with the EHDS Board, especially its subgroup for Chapters II and III of this Regulation, and, where applicable, the EDPB referred to in Article 68 of Regulation (EU) 2016/679.

RemovedArticle 24 – paragraph 1: 1. Manufacturers shall draw up technical documentation before the EHR system is placed on the market or put into service and shall be kept up-to-date.

RemovedArticle 24 – paragraph 2: 2. The technical documentation shall be drawn up in such a way as to demonstrate that the EHR system complies with the essential requirements laid down in Annex II and provide market surveillance authorities with all the necessary information to assess the conformity of the EHR system with those requirements. It shall contain, at a minimum, the elements set out in Annex III. Where the system or any part of it complies with European standards or common specifications, the list of the relevant European standards and common specifications shall also be indicated.

RemovedArticle 24 – paragraph 2 a (new): 2a. To ensure conformity, a single unified template for technical documentation shall be provided by the Commission.

RemovedArticle 24 – paragraph 3: 3. The technical documentation shall be drawn up in the official language of the Member State concerned. Following a reasoned request from the market surveillance authority of a Member State, the manufacturer shall provide a translation of the relevant parts of the technical documentation into the official language of that Member State.

RemovedArticle 25 – paragraph 1: 1. EHR systems shall be accompanied by an information sheet that includes concise, complete, correct and clear information that is relevant, accessible and comprehensible to professional users.

RemovedArticle 25 – paragraph 2 – point a: (a) the identity, registered trade name or registered trademark, and the contact details of the manufacturer including the postal and e-mail address and the telephone number and, where applicable, of its authorised representative;

RemovedArticle 25 – paragraph 2 – subparagraph 1a (new): If the EHR system is not accompanied by the information sheet referred to in this Article and by clear and complete instructions for use in accessible formats for persons with disabilities, the manufacturer of the EHR system concerned, its authorised representative and all other relevant economic operators shall be required to add to the EHR system that information sheet and those instructions for use.

RemovedArticle 26 – paragraph 3: 3. The EU declaration of conformity shall, as a minimum, contain the information set out in Annex IV and shall be translated into one or more official Union languages determined by the Member State(s) in which the EHR system is made available. Manufacturers shall provide a translation of the relevant parts of the technical documentation into the official language of the Member States where they have placed products on the market.

RemovedArticle 26 – paragraph 3 a (new): 3a. Digital EU declarations of conformity shall be made accessible online for the expected lifetime of the EHR system and in any event for at least 10 years after the placing on the market or the putting into service of the EHR system.

RemovedArticle 26 – paragraph 4: 4. By drawing up the EU declaration of conformity the manufacturer) shall assume responsibility for the compliance of the EHR system with the requirements laid down in this Regulation.

RemovedArticle 26 – paragraph 4 a (new): 4a. The Commission is empowered to adopt delegated acts in accordance with Article 67 in order to amend the minimum content of the EU declaration of conformity set out in Annex IV.

RemovedArticle 26 – paragraph 4 b (new): 4b. The Commission shall publish a standard uniformed template for the EU declaration of conformity and make it available in a digital format in all the official Union languages.

RemovedArticle 27 – paragraph 1 a (new): 1a. The CE marking shall be affixed before making the EHR system available on the market.

RemovedArticle 27 – paragraph 2 a (new): 2a. Where EHR systems are subject to other Union law in respect of aspects not covered by this Regulation, which also requires the affixing of the CE marking, the CE marking shall indicate that the systems also fulfil the requirements of that other law.

RemovedArticle 27 – paragraph 2 b (new): 2b. Member States shall build upon existing mechanisms to ensure correct application of the regime governing the CE marking and shall take appropriate action in the event of improper use of that marking.

RemovedArticle 27 a (new): Article 27a / Conformity assessment for EHR systems / 1. In order to certify the conformity of an EHR system with this Regulation, prior to placing an EHR system on the market, the manufacturer, its authorised representative, or any economic operator referred to in Article 21 shall apply for a conformity assessment procedure. / 2. The conformity assessment procedure shall require the notified body to assess: / (a) whether the EHR system is in conformity with the requirements laid down in Annex II; / (b) whether the EHR system is in conformity with the requirements laid down in Regulation (EU) .../... [.. (Cyber Resilience Act COM(2022)454]; / (c) whether the technical documentation is available and complete; / (d) whether the technical design of an EHR system meets the applicable requirements of this Regulation as provided for in an EU type examination procedure laid down in Annex IVa; / The EU type-examination is the part of a conformity assessment procedure in which a notified body examines the technical design of an EHR system and verifies and attests that the technical design of the EHR system meets the applicable requirements of this Regulation. / Only after an Union wide approval has been issued, may the CE marking be affixed, together with an identification number. / 3. Notified bodies shall take into account the specific interests and needs of SMEs when setting the fees for conformity assessment and reduce those fees proportionately to their specific interests and nee…

RemovedArticle 27 aa (new): Article 27aa / General principles of the CE marking / The CE marking shall be subject to the general principles set out in Article 30 of Regulation (EC) No 765/2008.

RemovedArticle 27 b (new): Article 27b / Notification / Member States shall notify the Commission and the other Member States of conformity assessment bodies authorised to carry out conformity assessments in accordance with this Regulation.

RemovedArticle 27 c (new): Article 27c / Notifying authorities / 1. Member States shall designate a notifying authority that shall be responsible for setting up and carrying out the necessary procedures for the assessment and notification of conformity assessment bodies and the monitoring of notified bodies, including compliance with Article 27h. / 2. Member States may decide that the assessment and monitoring referred to in paragraph 1 shall be carried out by a national accreditation body within the meaning of and in accordance with Regulation (EC) No 765/2008. / 3. Where the notifying authority delegates or otherwise entrusts the assessment, notification or monitoring referred to in paragraph 1 of this Article to a body, which is not a governmental entity that body shall be a legal entity and shall comply mutatis mutandis with the requirements laid down in Article 27e. In addition, that body shall have arrangements to cover liabilities arising out of its activities. / 4. The notifying authority shall take full responsibility for the tasks performed by the body referred to in paragraph 3.

RemovedArticle 27 d (new): Article 27d / Requirements relating to notifying authorities / 1. A notifying authority shall be established in such a way that no conflict of interest with conformity assessment bodies occurs. / 2. A notifying authority shall be organised and operated so as to safeguard the objectivity and impartiality of its activities. / 3. A notifying authority shall be organised in such a way that each decision relating to notification of a conformity assessment body is taken by competent persons other than those who carried out the assessment of the EHR system. / 4. A notifying authority shall not offer or provide any activities that conformity assessment bodies perform, or consultancy services on a commercial or competitive basis. / 5. A notifying authority shall safeguard the confidentiality of the information it obtains. / 6. A notifying authority shall have a sufficient number of competent personnel at its disposal for the proper performance of its tasks.

RemovedArticle 27 e (new): Article 27e / Information obligation on notifying authorities / Member States shall inform the Commission of their procedures for the assessment and notification of conformity assessment bodies and the monitoring of notified bodies, and of any changes thereto. The Commission shall make that information publicly available.

RemovedArticle 27 f (new): Article 27f / Requirements relating to notified bodies / 1. For the purposes of notification, a conformity assessment body shall meet the requirements laid down in paragraphs 2 to 11. / 2. A conformity assessment body shall be established under the national law of a Member State and have legal personality. / 3. A conformity assessment body shall be a third-party body independent of the organisation or the EHR system it assesses. / 4. A conformity assessment body, its top-level management and the personnel responsible for carrying out the conformity assessment tasks shall not be the designer, manufacturer, supplier, installer, purchaser, owner, user or maintainer of an EHR system, that they assess, or the representative of any of those parties. A conformity assessment body, its top-level management and the personnel responsible for carrying out the conformity assessment tasks shall not be directly involved in the design, manufacture, marketing, installation, use or maintenance of EHR systems, or represent the parties engaged in those activities. They shall not engage in any activity that may conflict with their independence of judgement or integrity in relation to conformity assessment activities for which they are notified. This shall in particular apply to consultancy services. A conformity assessment body shall ensure that the activities of its subsidiaries or subcontractors do not affect the confidentiality, objectivity or impartiality of its conformity assessment activiti…

RemovedArticle 27 g(new): Article 27g / Presumption of conformity of notified bodies / Where a conformity assessment body demonstrates its conformity with the criteria laid down in the relevant harmonised standards the references of which have been published in the Official Journal of the European Union, it shall be presumed to comply with the requirements set out in Article 27g in so far as the applicable harmonised standards cover those requirements.

RemovedArticle 27 h (new): Article 27h / Use of subcontractors and subsidiaries by notified bodies / 1. Where a notified body subcontracts specific tasks connected with conformity assessment or has recourse to a subsidiary, it shall ensure that the subcontractor or the subsidiary meets the requirements set out in Article 27f and shall inform the notifying authority accordingly. / 2. A notified body shall take full responsibility for the tasks performed by subcontractors or subsidiaries wherever those are established. / 3. Activities may be subcontracted or carried out by a subsidiary only with the agreement of the client. / 4. A notified body shall keep at the disposal of the notifying authority the relevant documents concerning the assessment of the qualifications of the subcontractor or the subsidiary and the work carried out by them under Annex IVa.

RemovedArticle 27 i (new): Article 27i / Application for notification / 1. A conformity assessment body shall submit an application for notification to the notifying authority of the Member State in which it is established. / 2. The application for notification shall be accompanied by a description of the conformity assessment activities, of the conformity assessment procedures set out in Annex IVa as well as by an accreditation certificate, where one exists, issued by a national accreditation body attesting that the conformity assessment body fulfils the requirements laid down in Article 27f. / 3. Where the conformity assessment body concerned cannot provide an accreditation certificate as referred to in paragraph 2, it shall provide the notifying authority with all the documentary evidence necessary for the verification, recognition and regular monitoring of its compliance with the requirements laid down in Article 27f.

RemovedArticle 27 j (new): Article 27j / Notification procedure / 1. A notifying authority shall notify only conformity assessment bodies which have satisfied the requirements laid down in Article 27f. / 2. The notifying authority shall send a notification to the Commission and the other Member States of each conformity assessment body referred to in paragraph 1, using the electronic notification tool developed and managed by the Commission. / 3. The notification referred to in paragraph 2 shall include the following: / (a) full details of the conformity assessment activities to be performed; / (b) the relevant attestation of competence. / 4. Where a notification is not based on an accreditation certificate referred to in Article 27i(2), the notifying authority shall provide the Commission and the other Member States with documentary evidence which attests to the conformity assessment body's competence and the arrangements in place to ensure that that body will be monitored regularly and will continue to satisfy the requirements laid down in Article 27f. / 5. The conformity assessment body concerned may perform the activities of a notified body only where no objections are raised by the Commission or the other Member States within two weeks of the validation of the notification where it includes an accreditation certificate referred to in Article 27i(2), or within two months of the notification where it includes documentary evidence referred to in paragraph 4 of this Article. / Only such a body shall b…

RemovedArticle 27 k (new): Article 27k / Identification numbers and lists of notified bodies / 1. The Commission shall assign an identification number to a notified body. It shall assign a single such number even where the body is notified under several Union acts. / 2. The Commission shall make publicly available the list of notified bodies including the identification numbers that have been assigned to them and the conformity assessment activities for which they have been notified. The Commission shall ensure that the list is kept up to date.

RemovedArticle 27 l (new): Article 27l / Changes to notification / 1. Where a notifying authority has ascertained or has been informed that a notified body no longer meets the requirements laid down in Article 27f, or that it is failing to fulfil its obligations as set out in Article 27n, the notifying authority shall restrict, suspend or withdraw the notification, as appropriate, depending on the seriousness of the failure to meet those requirements or fulfil those obligations. It shall immediately inform the Commission and the other Member States accordingly. / 2. In the event of restriction, suspension or withdrawal of notification, or where the notified body has ceased its activity, the notifying authority shall take appropriate steps to ensure that the files of that body are either processed by another notified body or kept available for the responsible notifying and market surveillance authorities at their request.

RemovedArticle 27 m (new): Article 27m / Challenge of the competence of notified bodies / 1. The Commission shall investigate all cases where it has doubts, or a doubt is brought to its attention, regarding the competence of a notified body or the continued fulfilment by a notified body of the requirements and responsibilities to which it is subject. / 2. The notifying authority shall provide the Commission, on request, with all information relating to the basis for the notification or the maintenance of the competence of the notified body concerned. / 3. The Commission shall ensure that all sensitive information obtained in the course of its investigations is treated confidentially. / 4. Where the Commission ascertains that a notified body does not meet or no longer meets the requirements for its notification, it shall adopt an implementing act requesting the notifying authority to take the necessary corrective measures, including the withdrawal of the notification if necessary. / That implementing act shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 27 n (new): Article 27n / Operational obligations of notified bodies / 1. A notified body shall carry out conformity assessments in accordance with the conformity assessment procedures set out in Article 27a. / 2. A notified body shall perform its activities in a proportionate manner, avoiding an unnecessary burden for economic operators, and taking due account of the size of an undertaking, the structure of the undertaking, the degree of complexity of the EHR system in question. In so doing, the notified body shall nevertheless respect the degree of rigour and the level of protection required for the compliance of the EHR system with the requirements of this Regulation. / 3. Where a notified body finds that the harmonised standards or common specifications referred in this Regulation have not been met by a manufacturer, it shall require the manufacturer to take appropriate corrective actions and shall not issue an EU type-examination certificate. / 4. Where, in the course of the monitoring of conformity following the issuance of a certificate of conformity or the adoption of an approval decision, a notified body finds that an EHR system no longer complies, it shall require the manufacturer to take appropriate corrective measures and shall suspend or withdraw the certificate of conformity or the approval decision, if necessary. / Where corrective measures are not taken or do not have the required effect, the notified body shall restrict, suspend or withdraw any certificates of conformity…

RemovedArticle 27 o (new): Article 27o / Appeals against decisions of notified bodies / A notified body shall ensure that a transparent and accessible appeals procedure against its decisions is available.

RemovedArticle 27 p (new): Article 27p / Information obligation on notified bodies / 1. A notified body shall inform the notifying authority of the following: / (a) any refusal, restriction, suspension or withdrawal of a certificate of conformity or approval decision; / (b) any circumstances affecting the scope of, or the conditions for, its notification; / (c) any request for information which it has received from market surveillance authorities regarding its conformity assessment activities; / (d) upon request, any conformity assessment activities performed within the scope of its notification and any other activity performed, including cross-border activities and subcontracting.

RemovedArticle 27 q (new): Article 27q / Coordination of notified bodies / The Commission shall ensure that appropriate coordination and cooperation between notified bodies are put in place and properly operated in the form of a sectoral group of notified bodies. / Notified bodies shall participate in the work of that group, directly or by means of designated representatives.

RemovedArticle 27 r (new): Article 27r / Exchange of experience / The Commission shall provide for the organisation of exchange of experience between the Member States' national authorities responsible for notification policy.

RemovedArticle 28 – paragraph 2: 2. Member States shall designate the market surveillance authority or authorities responsible for the implementation of this Chapter. They shall entrust their market surveillance authorities with the necessary powers, financial resources, equipment, technical expertise, adequate staffing, and knowledge necessary for the proper performance of their tasks pursuant to this Regulation. Member States shall communicate the identity of the market surveillance authorities to the Commission which shall publish a list of those authorities.

RemovedArticle 28 – paragraph 2 a (new): 2a. Staff of market surveillance authorities shall have no direct or indirect economic, financial or personal conflicts of interest that might be considered prejudicial to their independence and, in particular, they shall not be in a situation that may, directly or indirectly, affect the impartiality of their professional conduct.

RemovedArticle 28 – paragraph 2 b (new): 2b. Pursuant to paragraph 2 of this Article, Member States shall determine and publish the selection procedure for market surveillance authorities. They shall ensure that the procedure is transparent and does not allow for conflicts of interest.

RemovedArticle 28 – paragraph 4 a (new): 4a. Market surveillance authorities shall immediately inform notified bodies about manufacturers of EHR systems that no longer comply with the requirements on the declaration of conformity.

RemovedArticle 28 – paragraph 4 b (new): 4b. When a manufacturer or, pursuant to Article 21, another economic operator fails to cooperate with market surveillance authorities or if the information and documentation provided is incomplete or incorrect, market surveillance authorities shall take all appropriate measures to prohibit or restrict the relevant EHR system from being available on the market until the manufacturer cooperates or provides complete and correct information, or to withdraw it from the market or to recall.

RemovedArticle 29 – paragraph 1: 1. Where a market surveillance authority of one Member State has a reason to believe that an EHR system presents a risk to the health, safety or rights of natural persons, to the protection of personal data it shall carry out an evaluation in relation to the EHR system concerned covering all relevant requirements laid down in this regulation. Its authorised representatives and all other relevant economic operators shall cooperate as necessary with the market surveillance authorities for that purpose and take all appropriate measures to ensure that the EHR system concerned no longer presents that risk when placed on the market to withdraw the EHR system from the market or to recall it within a reasonable period. / The market surveillance authorities shall inform the relevant notified body accordingly.

RemovedArticle 29 – paragraph 1 a (new): 1a. Where the market surveillance authorities consider that non-compliance is not restricted to their national territory, they shall inform the Commission and the other Member States of the results of the evaluation and of the actions which they have required the economic operator to take.

RemovedArticle 29 – paragraph 1 b (new): 1b. Where a market surveillance authority considers or has reason to believe that an EHR system has caused damage to the health or safety of natural persons or to other aspects of public interest protection, it shall immediately provide information and documentation, as applicable, to the affected person or user and, as appropriate, other third parties affected by the damage caused to the person or user, without prejudice to data protection rules.

RemovedArticle 29 – paragraph 3: 3. The market surveillance authority, or, where applicable, the supervisory authority under Regulation (EU) 2016/679, shall immediately inform the Commission and the market surveillance authorities, or, if applicable, the supervisory authorities under Regulation (EU) 2016/679, of other Member States of the measures ordered pursuant to paragraph 1. That information shall include all available details, in particular the data necessary for the identification of the EHR system concerned, the origin and the supply chain of the EHR system, the nature of the risk involved and the nature and duration of the national measures taken.

RemovedArticle 29 – paragraph 3 a (new): 3a. Where a finding of a market surveillance authority, or a serious incident it is informed of, concerns personal data protection, the market surveillance authority shall immediately inform and cooperate with the relevant supervisory authorities under Regulation (EU) 2016/679.

RemovedArticle 29 – paragraph 4 – subparagraph 1: Manufacturers of EHR systems placed on the market shall report any serious incident involving an EHR system to the market surveillance authorities, or, in cases involving personal data, the supervisory authorities under Regulation (EU) 2016/679 of the Member States where such serious incident occurred and the corrective actions taken or envisaged by the manufacturer.

RemovedArticle 29 – paragraph 4 – subparagraph 2: Such notification shall be made, without prejudice to incident notification requirements under Directive (EU) 2016/1148, immediately after the manufacturer has established a causal link between the EHR system and the serious incident or the reasonable likelihood of such a link, and, in any event, not later than 7 days after the manufacturer becomes aware of the serious incident involving the EHR system.

RemovedArticle 29 – paragraph 5: 5. The authorities referred to in paragraph 4 shall inform the other authorities, without delay, of the serious incident and the corrective action taken or envisaged by the manufacturer or required of it to minimise the risk of recurrence of the serious incident.

RemovedArticle 30 – paragraph 1 – introductory part: 1. Where a market surveillance authority makes one, inter alia, of the following findings, it shall require the manufacturer of the EHR system concerned, its authorised representative and all other relevant economic operators to bring the EHR system into conformity:

RemovedArticle 30 – paragraph 1 – point a: (a) the EHR system is not in conformity with essential requirements laid down in Annex II and with the common specifications in accordance with Article 23;

RemovedArticle 30 – paragraph 1 – point b: (b) the technical documentation is not available, not complete or not in accordance with Article 24;

RemovedArticle 30 – paragraph 1 – point c: (c) the EU declaration of conformity has not been drawn up or has not been drawn up correctly as referred to in Article 26;

RemovedArticle 30 – paragraph 1 – point d a (new): (da) the registration obligations of Article 32 have not been fulfilled.

RemovedArticle 30 – paragraph 1 a (new): 1a. Where, in the course of the evaluation referred to in the first subparagraph, the market surveillance authorities find that the EHR system does not comply with the requirements laid down in this Regulation, they shall require without delay the relevant economic operator to take all appropriate corrective action to bring the EHR system into compliance with those requirements, to withdraw the EHR system from the market, or to recall it within a reasonable period.

RemovedArticle 30 – paragraph 1 b (new): 1b. Where the relevant economic operator does not take adequate corrective action within the period referred to in Article 29(1), second subparagraph, the market surveillance authorities shall take all appropriate provisional measures to prohibit or restrict the EHR system being made available on their national market, to withdraw the EHR system from that market or to recall it. / The market surveillance authorities shall inform the Commission and the other Member States, without delay, of those measures.

RemovedArticle 30 – paragraph 1 c (new): 1c. The information referred to in paragraph 1b, second subparagraph, shall include all available details, in particular the data necessary for the identification of the noncompliant EHR system, the origin of that EHR system, the nature of the non-compliance alleged and the risk involved, the nature and duration of the national measures taken and the arguments put forward by the relevant economic operator. In particular, the market surveillance authorities shall indicate whether the noncompliance is due to any of the following: / (a) failure of the EHR system to meet the requirements relating to the essential requirements set out in Annex II; / (b) shortcomings in the harmonised standards referred to in Article 23; / (c) shortcomings in the technical specifications referred to in Article 23.

RemovedArticle 30 – paragraph 1 d (new): 1d. Member States other than the Member State initiating the procedure under this Article shall without delay inform the Commission and the other Member States of any measures adopted and of any additional information at their disposal relating to the non-compliance of the EHR system concerned, and, in the event of disagreement with the adopted national measure, of their objections.

RemovedArticle 30 – paragraph 1 e (new): 1e. Where, within three months of receipt of the information referred to in paragraph 1b, second subparagraph, no objection has been raised by either a Member State or the Commission in respect of a provisional measure taken by a Member State, that measure shall be deemed justified.

RemovedArticle 30 a (new): Article 30a / Union safeguard procedure / 1. Where, on completion of the procedure set out in Article 29(2) and Article 30(1a), objections are raised against a measure taken by a Member State, or where the Commission considers a national measure to be contrary to Union law, the Commission shall without delay enter into consultation with the Member States and the relevant economic operator or operators and shall evaluate the national measure. On the basis of the results of that evaluation, the Commission shall adopt an implementing act in the form of a decision determining whether the national measure is justified or not. The Commission shall address its decision to all Member States and shall immediately communicate it to them and to the relevant economic operator or operators. That implementing act shall be adopted in accordance with the examination procedure referred to in Article 68(2a). / 2. If the national measure is considered justified, all Member States shall take the necessary measures to ensure that the non-compliant EHR system is withdrawn from their market, and shall inform the Commission accordingly. If the national measure is considered unjustified, the Member State concerned shall withdraw that measure. Where the national measure is considered justified and the non-compliance of the EHR system is attributed to shortcomings in the harmonised standards or technical specifications referred to in this Regulation, the Commission shall apply the procedure provided fo…

RemovedArticle 31 – title: Labelling of wellness applications

RemovedArticle 31 – paragraph 1: 1. Where a manufacturer of a wellness application claims interoperability with an EHR system and therefore compliance with the essential requirements laid down in Annex II and common specifications in Article 23, such wellness application shall be accompanied by a label, clearly indicating its compliance with those requirements. The label shall be issued by the manufacturer of the wellness application and the competent market surveillance authority shall be informed.

RemovedArticle 31 – paragraph 3: 3. The Commission shall, by means of implementing acts, determine the format and content of the label. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 31 – paragraph 4: 4. The label shall be drawn-up in one or more official languages of the Union, and in the language of the Member State(s) in which the wellness application is placed on the market.

RemovedArticle 31 – paragraph 6: 6. If the wellness application is an integral part of a device or embedded in a device after its putting into service, the accompanying label shall be shown in the application itself or placed on the device and in the case of software a digital label. 2D barcodes may also be used to display the label.

RemovedArticle 31 – paragraph 9: 9. Each distributor of a wellness application for which a label has been issued shall make the label available to customers at the point of sale in electronic form.

RemovedArticle 31 – paragraph 10: deleted

RemovedArticle 31 a (new): Article 31a / Interoperability of wellness applications with EHR systems / 1. Manufacturers of wellness applications may claim interoperability with an EHR system, after relevant conditions are met. When this is the case, the users of such wellness applications shall be duly informed about such interoperability and its effects. / 2. The interoperability of wellness applications with EHR systems shall not mean automatic sharing or transmission of all or part of the health data from the wellness application with the EHR system. The sharing or transmission of such data shall only be possible following the consent of the natural person and in accordance with Article 3(6) of this Regulation and interoperability shall be limited exclusively to this end. The manufacturers of wellness applications claiming interoperability with an EHR system shall ensure that the user is able to choose which categories of health data from the wellness application they want to insert in the EHR system and the circumstance for that sharing or transmission. / 3. Wellness applications shall not be permitted to access the information in EHRs or extract or process information from it.

RemovedArticle 32 – paragraph 1: 1. The Commission shall establish and maintain a publicly available database with information on EHR systems for which an EU declaration of conformity has been issued pursuant to Article 26 wellness applications for which a label has been issued pursuant to Article 34.

RemovedArticle 32 – paragraph 3: 3. Medical devices or high-risk AI systems referred to in paragraphs 3 and 4 of Article 14 of this Regulation shall also be registered in the database established pursuant to Regulations (EU) 2017/745 or […] [AI Act COM/2021/206 final], as applicable.

RemovedArticle 33 – title: Categories of electronic health data for secondary use

RemovedArticle 33 – paragraph 1 – introductory part: 1. This Chapter shall apply to the following categories of electronic health data available for secondary use:

RemovedArticle 33 – paragraph 1 – point a: (a) electronic health data from EHRs;

RemovedArticle 33 – paragraph 1 – point b: (b) data on factors impacting on health, including socio-economic, environmental and behavioural determinants of health;

RemovedArticle 33 – paragraph 1 – point c: (c) relevant pathogen data, impacting on human health;

RemovedArticle 33 – paragraph 1 – point d: (d) healthcare-related administrative data, including claims and reimbursement data;

RemovedArticle 33 – paragraph 1 – point e: (e) extracts from human genetic, genomic and proteomic data, such as genetic markers;

RemovedArticle 33 – paragraph 1 – point f: (f) automatically generated electronic health data, via medical devices;

RemovedArticle 33 – paragraph 1 – point f a (new): (fa) data from wellness applications;

RemovedArticle 33 – paragraph 1 – point g: (g) identification data related to healthcare providers and categories of health professionals involved in the treatment of a natural person or in research;

RemovedArticle 33 – paragraph 1 – point j: (j) electronic health data from clinical trials subject to transparency provisions under Union law;

RemovedArticle 33 – paragraph 1 – point l: (l) data from research cohorts, questionnaires and surveys related to health;

RemovedArticle 33 – paragraph 1 – point n: deleted

RemovedArticle 33 – paragraph 2: 2. The Commission, after consulting the EDPB, EDPS and the Member States, shall adopt guidelines on measures to protect the personal data of health professionals involved in the treatment of natural persons. / (deleted)

RemovedArticle 33 – paragraph 4: deleted

RemovedArticle 33 – paragraph 5: 5. Natural persons shall have the right to opt-out of the processing of their electronic health data for secondary use. Member States shall provide for an accessible and easily understandable opt-out mechanism, whereby natural persons shall be offered the possibility to explicitly express their wish not to have all or part of their personal electronic health data processed for some or all secondary use purposes. The exercise of this right to opt-out shall not affect the lawfulness of the processing that took place under Chapter IV before the individual opted-out.

RemovedArticle 33 – paragraph 5 a (new): 5a. Without prejudice to paragraph 5, electronic health data referred to under paragraph 1, points (e), (fa) and (m), shall only be made available for secondary use after obtaining the consent of the natural person. Such an opt-in mechanism shall be easily understandable and accessible and provided in a user-friendly format whereby data subjects are made aware of the sensitive nature of the data.

RemovedArticle 33 – paragraph 7: deleted

RemovedArticle 33 – paragraph 8: deleted

RemovedArticle 33 a (new): Article 33a / IP rights and trade secrets in secondary use / Electronic health data entailing content protected by intellectual property rights, trade secrets or data covered by regulatory data protection shall be made available for secondary use. In those cases, the following procedure shall apply: / (a) health data access bodies shall take measures necessary to preserve the confidentiality of such data and to ensure such rights are not infringed; / (b) the Commission shall, after consultation with the EHDS Board, issue guidelines on the identification of commercially confidential information. The guidelines shall outline procedural steps and measures the health data access bodies may undertake to identify and preserve the confidentiality of such information before providing data access to the health data users. The guidance shall be made publicly available; / (c) health data holders may, when requested to make available to health data access bodies relevant electronic health data pursuant to Article 41(1) which it considers to contain content protected by intellectual property rights, trade secrets or data covered by regulatory data protection, inform the data access body that this is the case and indicate which parts of the datasets are concerned. The determination of which data contains intellectual property, trade secrets or data covered by regulatory data protection shall nevertheless rest with the health data access body; / (d) health data holders and the health data u…

RemovedArticle 34 – paragraph 1 – introductory part: 1. Health data access bodies shall only provide access to electronic health data referred to in Article 33 to a health data user where the processing of the data by the data user is necessary for one of the following purposes, and in accordance with Article 6(1), point (c), and Article 9(2), points (g) to (j), of Regulation (EU) 2016/679:

RemovedArticle 34 – paragraph 1 – point a: (a) activities for reasons of public interest in the area of public health, such as protection against serious cross-border threats to health, public health surveillance or ensuring high levels of quality and safety of healthcare and of medicinal products or medical devices;

RemovedArticle 34 – paragraph 1 – point b: (b) to support public sector bodies and Union institutions, agencies and bodies, in the health or care sector to carry out their tasks defined in their mandates where processing is necessary for reasons of substantial public interest in the area of public health;

RemovedArticle 34 – paragraph 1 – point c: (c) to produce national, multi-national and Union level official statistics defined in Regulation (EU) No 223/20091a related to health or care sectors; / 1a Regulation (EC) No 223/2009 of the European Parliament and of the Council of 11 March 2009 on European statistics and repealing Regulation (EC, Euratom) No 1101/2008 of the European Parliament and of the Council on the transmission of data subject to statistical confidentiality to the Statistical Office of the European Communities, Council Regulation (EC) No 322/97 on Community Statistics, and Council Decision 89/382/EEC, Euratom establishing a Committee on the Statistical Programmes of the European Communities (OJ L 87, 31.3.2009, p. 164).

RemovedArticle 34 – paragraph 1 – point d: deleted

RemovedArticle 34 – paragraph 1 – point e: (e) scientific research related to health or care sectors, contributing to public health or health technology assessment, or ensuring high levels of quality and safety of health care, of medicinal products or of medical devices, with the aim of benefitting the end-users, such as patients, health professionals and health administrators, including: / (i) development and innovation activities for products or services; / (ii) training, testing and evaluating of algorithms, including in medical devices, in-vitro diagnostic medical devices, AI systems and digital health applications; / (iii) university and post-university teaching activities related to scientific research.

RemovedArticle 34 – paragraph 1 – point f: deleted

RemovedArticle 34 – paragraph 1 – point g: deleted

RemovedArticle 34 – paragraph 1 – point h: (h) improving delivery of care, treatment optimisation and providing personalised healthcare.

RemovedArticle 34 – paragraph 2: 2. The purposes referred to in points (a) to (c) of paragraph 1 shall be reserved for public sector bodies and Union institutions, bodies, offices and agencies exercising their tasks conferred to them by Union or national law, including where processing of data for carrying out these tasks is done by a third party on behalf of that public sector body or of Union institutions, agencies and bodies.

RemovedArticle 34 – paragraph 4: deleted

RemovedArticle 35 – paragraph -1 (new): -1. Secondary use of electronic health data that is not covered by the data permit pursuant to Article 46 or data requests pursuant to Article 47 shall be prohibited.

RemovedArticle 35 – paragraph -1 a (new): -1a. Any secondary use of electronic health data for purposes other than those referred to in Article 34 shall be prohibited.

RemovedArticle 35 – paragraph 1 – introductory part: 1. Seeking access to and processing electronic health data obtained via a data permit issued pursuant to Article 46 or a data request granted pursuant to Article 47 for the following purposes shall be prohibited:

RemovedArticle 35 – paragraph 1 – point a: (a) taking decisions detrimental to a natural person or group of natural persons based on their electronic health data; in order to qualify as “decisions”, they must produce legal, economic or social effects or similarly significantly affect those natural persons;

RemovedArticle 35 – paragraph 1 – point b: (b) taking decisions in relation to a natural person or groups of natural persons in relation to job offers or offering less favourable terms in the provision of goods or services, including to exclude them from the benefit of an insurance or credit contract or to modify their contributions and insurance premiums or conditions of loans, or taking any other decisions in relation to a natural person or groups of natural persons having the effect of discriminating on the basis of the health data obtained;

RemovedArticle 35 – paragraph 1 – point c: (c) advertising or marketing activities;

RemovedArticle 35 – paragraph 1 – point e: (e) developing products or services that may harm individuals, public health or societies at large, including, but not limited to illicit drugs, alcoholic beverages, tobacco and nicotine products, weaponry or products or services which are designed or modified in such a way that they create addiction or that they contravene public order or morality;

RemovedArticle 35 – paragraph 1 – point e a (new): (ea) automated individual decision-making, including profiling, in accordance with Article 22 of the Regulation (EU) 2016/679, whether solely on the basis of the datasets shared under this Regulation or in combination with other data.

RemovedArticle 36 – paragraph 1: 1. Member States shall designate one or more health data access bodies responsible for the tasks and obligations referred to in Articles 37, 38 and 39 of this Regulation. Member States may either establish one or more new public sector bodies or rely on existing public sector bodies or on internal services of public sector bodies that fulfil the conditions set out in this Article. / Where a Member State designates several health data access bodies, it shall designate one health data access body to act as coordinator, with responsibility for coordinating data access applications and requests with the other health data access bodies. / Each health data access body shall contribute to the consistent application of this Regulation throughout the Union. For that purpose, the health data access bodies shall cooperate with each other and with the Commission, and, for concerns regarding data protection, with the supervisory authorities under Regulation (EU) 2016/679 as well as with the EDPB and the EDPS.

RemovedArticle 36 – paragraph 2: 2. Member States shall ensure that each health data access body is provided with the human and financial resources, including necessary expertise, and ethics bodies, to support their tasks as provided for in Article 37(1), points (a) and (aa), and shall guarantee that all rights of natural persons under this Chapter are respected. / Member States shall also ensure technical resources, premises and infrastructure necessary for the effective performance of its tasks and the exercise of its powers, in a timely manner.

RemovedArticle 36 – paragraph 2 a (new): 2a. Member States shall ensure that designated separate structures are set up within health data access bodies for the authorisation of the data permit, on the one hand, and for the reception and preparation of the data set, including anonymisation, pseudonymisation of the electronic health data and possible re-identification of natural persons for the purposes of Article 33(5) and 38(3), on the other hand.

RemovedArticle 36 – paragraph 3: 3. In the performance of their tasks, health data access bodies shall actively cooperate with relevant stakeholders’ representatives, especially with representatives of patients, consumers, data holders and data users.

RemovedArticle 36 – paragraph 3 a (new): 3a. Each health data access body shall act with complete independence in performing its tasks and exercising its powers in accordance with this Regulation. The members of the governance and decision-making bodies and staff of each health data access body shall, in the performance of their tasks and exercise of their powers in accordance with this Regulation, remain free from external influence, whether direct or indirect and shall neither seek nor take instructions from any natural or legal person. Members of the governance and decision-making bodies and staff of each health data access body shall refrain from any action incompatible with their duties and shall not, during their term of office, engage in any incompatible occupation, whether gainful or not.

RemovedArticle 37 – paragraph 1 – point a: (a) decide on data access applications pursuant to Article 45, including deciding on whether the data shall be made accessible in anonymised or pseudonymised form, based on its own thorough assessment of any reasons provided by the health data applicant pursuant to Article 45(2), point (d);

RemovedArticle 37 – paragraph 1 – point a a (new): (aa) assess and issue data permits pursuant to Article 46 of this Regulation and assess data request pursuant to Article 47 of this Regulation to access electronic health data falling within their national remit for secondary use and decide on data requests in accordance with Chapter II of Regulation (EU) .../... […] [Data Governance Act COM/2020/767 final] and this Chapter;

RemovedArticle 37 – paragraph 1 – point a b (new): (ab) request electronic health data referred to in Article 33 from relevant health data holders pursuant to a data permit or a data request granted;

RemovedArticle 37 – paragraph 1 – point d: (d) process electronic health data for the purposes set out in Article 34, including the combination, preparation, anonymisation and pseudonymisation and disclosure of those data for secondary use on the basis of a data permit, while also ensuring proper security of that data;

RemovedArticle 37 – paragraph 1 – point e: deleted

RemovedArticle 37 – paragraph 1 – point f: (f) take all measures necessary to preserve the confidentiality of IP rights and regulatory data protection, and the confidentiality of trade secrets as provided for in Article 33a;

RemovedArticle 37 – paragraph 1 – point g: (g) based on a data permit, put the relevant electronic health data at the disposal of data users in a secure processing environment in accordance with the requirements laid down in Article 50 and store the data for the period of the duration of the data permit;

RemovedArticle 37 – paragraph 1 – point i: deleted

RemovedArticle 37 – paragraph 1 – point j a (new): (ja) support data holders that are small enterprises in accordance with Commission Recommendation 2003/361/EC, in particular medical practitioners and pharmacies, to comply with their obligations under Article 41;

RemovedArticle 37 – paragraph 1 – point k: (k) maintain a management system to record and process data access applications, data requests, the decisions on those applications and the data permits issued and data requests answered, providing at least information on the name of the data applicant, the purpose of access the date of issuance, duration of the data permit and a description of the data application or the data request;

RemovedArticle 37 – paragraph 1 – point m: (m) cooperate at Union and national level to lay down common standards, technical requirements and appropriate measures for accessing electronic health data in a secure processing environment;

RemovedArticle 37 – paragraph 1 – point n: (n) cooperate at Union and national level and provide advice to the Commission on techniques and best practices for the secondary use and management of electronic health data;

RemovedArticle 37 – paragraph 1 – point q – point i: (i) a national dataset catalogue that shall include details about the source and nature of electronic health data, in accordance with Articles 55, 56 and 58, and the conditions for making electronic health data available. The national dataset catalogue shall also be made available to single information points under Article 8 of Regulation […] [Data Governance Act COM/2020/767 final];

RemovedArticle 37 – paragraph 1 – point q – point ii: (ii) all health data applications and requests without undue delay after their reception;

RemovedArticle 37 – paragraph 1 – point q – point ii a (new): (iia) all health data permits or requests granted as well as denied, together with a justification, within 30 working days of their issuance;

RemovedArticle 37 – paragraph 1 – point q – point iii: (iii) enforcement measures applied pursuant to Article 43 and administrative fines applied pursuant to Article 43a;

RemovedArticle 37 – paragraph 1 – point r a (new): (ra) monitor and supervise compliance by data users and data holders with the requirements laid down in this Chapter; monitoring and supervision shall include regular audits on health data users regarding their processing of electronic health data in the secure processing environment;

RemovedArticle 37 – paragraph 2 – point a: (a) cooperate with supervisory authorities under Regulation (EU) 2016/679 in relation to personal electronic health data and the EHDS Board;

RemovedArticle 37 – paragraph 2 – point a a (new): (aa) immediately notify the relevant supervisory authorities under Regulation (EU) 2016/679 of any potential issue related to the processing of personal electronic health data for secondary use, and exchange any relevant information at their disposal to ensure application and enforcement of this Regulation and relevant provisions of Regulation (EU) 2016/679 and this Regulation, including penalties;

RemovedArticle 37 – paragraph 2 – point b: (b) inform the relevant supervisory authorities under Regulation (EU) 2016/679 where a health data access body has imposed enforcement measures pursuant to Article 43 or administrative fines pursuant to Article 43a in relation to processing personal electronic health data and where such processing refers to an attempt to re-identify an individual or unlawful processing of personal electronic health data;

RemovedArticle 37 – paragraph 2 – point c: (c) cooperate with all relevant stakeholders, including patient organisations, representatives from natural persons, health professionals, researchers, and ethics committees, where applicable in accordance with Union and national law;

RemovedArticle 37 – paragraph 4: deleted

RemovedArticle 38 – paragraph 1 – introductory part: 1. Health data access bodies shall make publicly available and easily searchable and accessible for natural persons the conditions under which electronic health data is made available for secondary use, with information concerning:

RemovedArticle 38 – paragraph 1 – point a: (a) the legal basis under which access is granted to the health data user;

RemovedArticle 38 – paragraph 1 – point c: (c) the applicable rights of natural persons in relation to secondary use of electronic health data, including the right to opt-out pursuant to Article 33(5) and the right to opt-in pursuant to Article 33(5a), and detailed information on how to exercise them;

RemovedArticle 38 – paragraph 1 – point d: (d) the modalities for natural persons to exercise their rights in accordance with Chapter III of Regulation (EU) 2016/679;

RemovedArticle 38 – paragraph 1 – point d a (new): (da) the identity and the contact details of the health data access body;

RemovedArticle 38 – paragraph 1 – point d b (new): (db) the record on who has been granted access to which sets of electronic health data and a justification regarding the purposes for processing them as referred to in Article 34(1);

RemovedArticle 38 – paragraph 2: deleted

RemovedArticle 38 – paragraph 3: 3. Where a health data access body is informed by a health data user of a significant finding related to the health of a natural person, as referred to in Article 41a(5) of this Regulation, the health data access body shall inform the treating health professional with the relevant competence of the natural person and if that health professional cannot be found, and shall inform the natural person about that finding. Natural persons shall have the right to request not to be informed of such findings. In accordance with Article 23(1), point (i), of Regulation (EU) 2016/679, Member States may restrict the scope of the obligation to inform the natural persons whenever necessary for the protection of the natural persons based on patient safety and ethics, by delaying the communication of their information until a health professional can communicate and explain to the natural persons information that potentially can have an impact on them .

RemovedArticle 38 a (new): Article 38a / Right to lodge a complaint with a health data access body / 1. Without prejudice to any other administrative or judicial remedy, natural and legal persons shall have the right to lodge a complaint, individually or, where relevant, collectively, with the health data access body, where their rights laid down in this Chapter are affected. Where the complaint concerns the rights of natural persons pursuant to Article 38(1), point (d), of this Regulation, the health data access body shall inform and send a copy of the complaint to the competent supervisory authorities under Regulation (EU) 2016/679. / 2. The health data access body with which the complaint has been lodged shall inform the complainant of the progress of the proceedings and of the decision taken. / 3. Health data access bodies shall cooperate to handle and resolve complaints, including by exchanging all relevant information by electronic means, without undue delay. / 4. Each health data access body shall facilitate submitting complaints, in particular by providing a complaint submission form which can also be completed electronically, without excluding the possibility of using other means of communication.

RemovedArticle 38 b (new): Article 38b / Right to an effective judicial remedy against a health data access body / 1. Without prejudice to any other administrative or non-judicial remedy, each natural or legal person shall have the right to an effective judicial remedy against a legally binding decision of a health data access body concerning them. / 2. Without prejudice to any other administrative or non-judicial remedy, each natural or legal person shall have the right to an effective judicial remedy where the health data access body which is competent pursuant to Article 37 does not handle a complaint or does not inform the natural or legal person within three months about the progress or outcome of the complaint lodged pursuant to Article 38a. / 3. Proceedings against a health data access body shall be brought before the courts of the Member States where the health data access body is established.

RemovedArticle 39 – paragraph 1 – introductory part: 1. Each health data access body shall publish an annual activity report and make it publicly available on its website, which shall contain at least the following categories of information:

RemovedArticle 39 – paragraph 1 – point a: (a) information relating to the data access applications and data requests for electronic health data access submitted, such as the types of applicants, number of data permits granted or refused, purposes of access and categories of electronic health data accessed, and a summary of the results of the electronic health data uses, where applicable;

RemovedArticle 39 – paragraph 1 – point c: (c) information on the fulfilment of regulatory and contractual commitments by data users and data holders, as well as the number and amount of administrative fines imposed by health data access bodies;

RemovedArticle 39 – paragraph 1 – point d: (d) information on audits carried out on data users to ensure compliance of the processing within the secure processing environment as referred to in Article 50 of this Regulation;

RemovedArticle 39 – paragraph 1 – point e: (e) information on internal and third party audits on compliance of secure processing environments with the defined standards, specifications and requirements, as referred to in Article 50(3) of this Regulation;

RemovedArticle 39 – paragraph 1 – point j: deleted

RemovedArticle 39 – paragraph 1 – point l: (l) number of data quality labels issued by data holders, disaggregated per quality category;

RemovedArticle 39 – paragraph 2: 2. The report shall be transmitted to the Commission, which shall make it publicly available on its website.

RemovedArticle 39 – paragraph 3: 3. The Commission is empowered to adopt delegated acts in accordance with Article 67 to amend paragraph 1 of this Article by adding categories to those listed in that paragraph.

RemovedArticle 40 – paragraph 1: 1. In addition to rules regarding data altruism established by Regulation (EU) 2022/868, where data altruism organisations recognised under Chapter IV of that Regulation process personal electronic health data using a secure processing environment, such environments shall also comply with the requirements set out in Article 50 of this Regulation.

RemovedArticle 40 – paragraph 2: 2. Health data access bodies shall support the competent authorities designated in accordance with Article 23 of Regulation (EU) 2022/868 in the monitoring of entities carrying out data altruism activities, where electronic health data are concerned.

RemovedArticle 41 – title: Duties of health data holders

RemovedArticle 41 – paragraph 1: 1. Health data holders shall make relevant electronic health data under Article 33 available upon request to the health data access body pursuant to a data permit issued or data request granted by such a body. Health data holders shall cooperate in good faith with the health data access bodies, where relevant.

RemovedArticle 41 – paragraph 1 a (new): 1a. The requirement laid down in the first paragraph shall not apply to data holders that qualify as micro enterprises as defined in Article 2 of the Annex to Commission Recommendation 2003/361/EC.

RemovedArticle 41 – paragraph 1 b (new): 1b. The health data holder shall put the electronic health data at the disposal of the health data access body within three months of receiving the request from the health data access body. In justified cases, after consultation with the health data holder concerned, that period may be extended by the health data access body for a maximum of two months. The health data access body may decide that the extension is to be shorter than two months.

RemovedArticle 41 – paragraph 1 c (new): 1c. Paragraphs 1 and 1a of this Article constitute a legal obligation pursuant to Article 6(1), point (c), of this Regulation in combination with Article 9(2), points (g) to (j), of Regulation 2016/679 for the health data holder to disclose personal electronic health data to the health data access body.

RemovedArticle 41 – paragraph 2: 2. The health data holder shall communicate to the health data access body a general description of the dataset it holds in accordance with Article 55.

RemovedArticle 41 – paragraph 3: 3. Where a data quality and utility label accompanies the dataset pursuant to Article 56, the health data holder shall provide sufficient documentation to the health data access body for that body to confirm the accuracy of the label.

RemovedArticle 41 – paragraph 4: deleted

RemovedArticle 41 – paragraph 5: 5. Where a health data holder has received enriched datasets following a processing based on a data permit, it shall make available the new dataset, unless it considers it unsuitable and notifies the health data access body in this respect.

RemovedArticle 41 – paragraph 6: 6. Health data holders of non-personal electronic health data shall ensure access to data through trusted open databases to ensure unrestricted access for all users and data storage and preservation. Trusted open public databases shall have in place a robust, transparent and sustainable governance and a transparent model of user access.

RemovedArticle 41 – paragraph 7: deleted

RemovedArticle 41 a (new): Article 41a / Duties of health data users / 1. Health data users may access and process the electronic health data for secondary use referred to in Article 33 only in accordance with the data permit issued by the health data access body in accordance with Article 46 of this Regulation. / 2. Health data users shall not re-identify or seek to re-identify the natural persons to whom the electronic health data which they obtained based on the data permit or data request belong. Such conduct shall be considered a serious breach of this Regulation. / 3. Health data users shall make public the results or output of the secondary use of electronic health data, including information relevant for the provision of healthcare, no later than 18 months after the completion of the electronic health data processing or after having received the answer to the data request referred to in Article 47. Those results or output shall not contain personal data. In justified cases, especially cases referred to in Article 34(1), point (e), that period may be extended by the relevant health data access body, after consultation with the health data user. The health data users shall inform the health data access bodies from which a data permit was obtained about the results or output and provide them with necessary support in order to make them public also on health data access bodies’ websites. The result shall also be made publicly available in lay summaries. Whenever the health data users have used elec…

RemovedArticle 42 – paragraph 1: 1. Health data access bodies may charge fees to health data users for making electronic health data available for secondary use. Any fees shall include and be derived from the costs related to the set up, combination, preparation, anonymisation, pseudonymisation, maintenance, tasks under Article 33a, making available or updating of the dataset and conducting the procedure for requests, including for assessing a data application or a data request, granting, refusing or amending a data permit pursuant to Articles 45 and 46 or providing an answer to a data request pursuant to Article 47, in accordance with Article 6 of Regulation […] [Data Governance Act COM/2020/767 final]. No fees shall be charged to public sector bodies and Union institutions, offices, agencies and bodies when making data available for the purposes referred to in Article 34(1), points (a), (b) and(c). No fees shall be charged to public sector bodies or Union institutions, offices, agencies and bodies with a legal mandate in the field of public health.

RemovedArticle 42 – paragraph 2: 2. In the case of health data holders, where the data in question are not held by the health data access body or a public sector body or a Union institution, office, agency and body, the fees may be derived from the costs for gathering, enriching, and preparing the electronic health data specifically under this Regulation in addition to the fees that may be charged pursuant to paragraph 1. The part of the fees linked to the health data holder’s costs shall be paid to the health data holder.

RemovedArticle 42 – paragraph 4: 4. Any fees charged to health data users pursuant to this Article by the health data access bodies or health data holders shall be transparent, non-discriminatory, and proportionate to the cost of making electronic health data available for secondary use, objectively justified and shall not restrict competition. The support received by the health data holder from donations, public national or Union funds, to set up, develop or update that dataset shall be excluded from this calculation. The specific interests and needs of SMEs, public bodies, Union institutions, bodies, offices and agencies involved in research, health policy or analysis, academic and educational institutions, non-commercial entities and healthcare providers shall be taken into account when setting the fees, by reducing those fees proportionately to their size or budget.

RemovedArticle 42 – paragraph 5: 5. Where health data holders and health data users do not agree on the level of the fees within 1 month of the data permit being granted, the health data access body may set the fees in proportion to the cost of making available electronic health data for secondary use. Where the health data holder or the health data user disagree with the fee set out by the health data access body, they shall have access to dispute settlement bodies set out in accordance with Article 10 of the Regulation […] [Data Act COM/2022/68 final].

RemovedArticle 42 – paragraph 6: 6. The Commission shall, by means of implementing acts, lay down principles and rules for the fee policies and fee structures, including deductions for the entities listed in paragraph 4, second sub-paragraph. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 43 – title: Enforcement by health data access bodies

RemovedArticle 43 – paragraph 1: deleted

RemovedArticle 43 – paragraph 2: 2. When carrying out its monitoring and supervisory tasks to verify compliance with this Chapter, as referred to in Article 37(1), point (ra), the health data access bodies shall request information from health data holders and users that is proportionate for the performance of the task.

RemovedArticle 43 – paragraph 3: 3. Where health data access bodies find that a health data user or health data holder does not comply with the requirements of this Chapter, they shall immediately notify the health data user or health data holder of those findings and shall give it the opportunity to state its views within 4 weeks. / Where the finding of non-compliance concerns a possible breach of Regulation (EU) 2016/679, the health data access body shall immediately inform the supervisory authorities under Regulation (EU) 2016/679 and provide them with all relevant information at their disposal concerning this finding to ensure application and enforcement of the relevant provisions of that Regulation, including penalties.

RemovedArticle 43 – paragraph 4: 4. Health data access bodies shall have the power to revoke the data permit issued pursuant to Article 46 and stop the affected electronic health data processing operation carried out by the health data user in order to ensure the cessation of the non-compliance referred to in paragraph 3, immediately or without undue delay, and shall take appropriate and proportionate measures aimed at ensuring compliant processing by the health data users. In this regard, the health data access bodies shall be able, where appropriate, to revoke the data permit and to exclude the health data user from any access to electronic health data for a period of up to 5 years.

RemovedArticle 43 – paragraph 5: 5. Where health data holders withhold the electronic health data from health data access bodies with the manifest intention of obstructing the use of electronic health data, or do not respect the deadlines set out in Article 41, the health data access body shall have the power to fine the health data holder with fines for each day of delay, which shall be transparent and proportionate. The amount of the fines shall be established by the health data access body. In case of repeated breaches by the health data holder of the obligation of loyal cooperation with the health data access body, that body can exclude the health data holder from submitting data access applications pursuant to Chapter IV for a period of up to 5 years, while still being obliged to make data accessible pursuant to Chapter IV, where applicable.

RemovedArticle 43 – paragraph 6: 6. The health data access body shall communicate the measures imposed pursuant to paragraphs 4 and 5 and the reasons on which they are based to the health data user or holder concerned, without delay, and shall lay down a reasonable period for the health data user or holder to comply with those measures.

RemovedArticle 43 – paragraph 7: 7. Any enforcement measures imposed pursuant to paragraph 4 shall be notified to other health data access bodies and made publicly available on the website of the EHDS Board.

RemovedArticle 43 – paragraph 7 a (new): 7a. The health data access body shall ensure coherent enforcement based on the provisions of this Regulation and Regulation (EU) 2016/679 by taking into account any decision or investigation ongoing in supervisory authorities.

RemovedArticle 43 – paragraph 9: deleted

RemovedArticle 43 – paragraph 10: 10. The Commission shall issue guidelines on enforcement measures to be applied by the health data access bodies, in accordance with the principles set out in Article 68a.

RemovedArticle 43 a (new): Article43a / General conditions for the imposition of administrative fines by health data access bodies / 1. Each health data access body shall ensure that the imposition of administrative fines pursuant to this Article in respect of infringements referred to in paragraphs 4 and 5 shall in each individual case be effective, proportionate and dissuasive. / 2. Administrative fines shall, depending on the circumstances of each individual case, be imposed in addition to, or instead of, measures referred to in Article 43(4) and (5). When deciding whether to impose an administrative fine and deciding on the amount of the administrative fine in each individual case due regard shall be given to the following: / (a) the nature, gravity and duration of the infringement; / (b) whether any penalties or administrative fines have already been applied by other competent authorities to the same infringing party for the same infringement; / (c) the intentional or negligent character of the infringement; / (d) any action taken by the health data holder or health data user to mitigate the damage suffered by natural persons; / (e) the degree of responsibility of the health data user, taking into account technical and organisational measures implemented by them pursuant to Article 45(2), points (e) and (f),and Article 45(4); / (f) any relevant previous infringements by the health data holder or health data user; / (g) the degree of cooperation with the health data access body, in order to remedy …

RemovedArticle 44 – paragraph 1: 1. The health data access body shall ensure that access is only provided to requested electronic health data that are adequate, relevant and limited to what is necessary in relation to the purpose of processing indicated in the data access application by the data user and in line with the data permit granted.

RemovedArticle 44 – paragraph 2: 2. The health data access bodies shall provide the electronic health data in an anonymised format, in any event where the purpose of processing by the health data user can be achieved with such data, taking into account the information provided by the health data user.

RemovedArticle 44 – paragraph 3: 3. Where the health data user has sufficiently demonstrated that the purpose of processing cannot be achieved with anonymised data in line with Article 46(1c), taking into account the information provided by the health data user the health data access bodies shall provide access to electronic health data in pseudonymised format. The information necessary to reverse the pseudonymisation shall be available only to the health data access body. Health Data users shall not re-identify the electronic health data provided to them in anonymised or pseudonymised format.

RemovedArticle 44 – paragraph 3 a (new): 3a. The health data user’s failure to respect the health data access body’s measures ensuring anonymisation and pseudonymisation shall be considered a particularly serious breach of this Regulation and shall be subject to effective, proportionate and dissuasive penalties.

RemovedArticle 44 – paragraph 3 b (new): 3b. The Commission shall, by means of implementing acts, set out the procedures and requirements, and provide technical tools, for a unified procedure for anonymising and pseudonymising the electronic health data. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 45 – paragraph 1: 1. Health data applicants may submit a data access application for the purposes referred to in Article 34.

RemovedArticle 45 – paragraph 2 – point -a (new): (-a) the health data applicant´s identity, description of professional functions and operations, including the identity of the natural persons who will have access to electronic health data, if a data permit is granted; the list of natural persons can be updated and in that case it shall be notified to the health data access body;

RemovedArticle 45 – paragraph 2 – point a: (a) a detailed explanation of the intended use of the electronic health data including for which of the purposes referred to in Article 34(1), access is necessary;

RemovedArticle 45 – paragraph 2 – point a a (new): (aa) a description of how the health data applicant is qualified vis-à-vis the intended purposes of data use, including professional qualifications to demonstrate appropriate expertise, consistent with ethical practice and applicable laws and regulations;

RemovedArticle 45 – paragraph 2 – point a b (new): (ab) an explanation of the expected benefits and how these benefits contribute to the purposes referred to in Article 34(1);

RemovedArticle 45 – paragraph 2 – point b: (b) a description of the requested electronic health data, their timeframe, format and data sources, where possible, including geographical coverage where data is requested from several Member States;

RemovedArticle 45 – paragraph 2 – point c: (c) an explanation whether electronic health data needs to be made available in a pseudonymised format and why the envisaged purpose for processing cannot be pursued using anonymised data;

RemovedArticle 45 – paragraph 2 – point d: (d) a description of the safeguards planned to prevent any other use or any misuse of the electronic health data;

RemovedArticle 45 – paragraph 2 – point e: (e) a description of the safeguards proportionate to the risks, planned to protect the rights and interests of the health data holder;

RemovedArticle 45 – paragraph 2 – point f: (f) for personal electronic health data, a description of the necessary technical and organisational measures pursuant to Article 32 of Regulation (EU) 2016/679; to protect the rights and interests of the natural persons concerned, including to prevent any re-identification of natural persons in the dataset;

RemovedArticle 45 – paragraph 2 – point g: (g) a justified estimation of the period during which the electronic health data is needed for processing;

RemovedArticle 45 – paragraph 2 – point h a (new): (ha) where applicable, information on the assessment of ethical aspects of the processing and details of any necessary ethics approval obtained by the competent ethics committee in line with national law, which may serve to replace their own ethics assessment;

RemovedArticle 45 – paragraph 2 – point h b (new): (hb) a plan defining audiences and tools to provide information publicly on the results or outcomes of the access to the data in accordance with Article 46(11);

RemovedArticle 45 – paragraph 2 – point h c (new): (hc) a declaration that the intended uses of the data requested do not pose a risk of stigmatisation of or causing harm to the dignity of individuals or the groups to which the dataset requested relates.

RemovedArticle 45 – paragraph 3: 3. Health data applicants seeking access to electronic health data from more than one Member State shall submit a single application to one of the concerned health data access bodies of their choice which shall be responsible for sharing the application with the other health data access bodies and authorised participants in HealthData@EU referred to in Article 52, which have been identified in the data access application. In such a case, the health data access body shall notify the other relevant health data access bodies of the receipt of an application relevant to them within 15 days from the date of receipt of the data access application.

RemovedArticle 45 – paragraph 4 – introductory part: 4. Where the health data applicants intend to access the personal electronic health data in a pseudonymised format, the following additional information shall be provided together with the data access application:

RemovedArticle 45 – paragraph 4 – point a: (a) a description of how the processing would comply with applicable Union and national law on data protection and privacy, notably Regulation (EU) 2016/679;

RemovedArticle 45 – paragraph 4 – point b: deleted

RemovedArticle 45 – paragraph 5 – subparagraph 2: deleted

RemovedArticle 45 – paragraph 6: 6. The Commission shall, by means of implementing acts, set out the templates for the data access application referred to in this Article, the data permit referred to in Article 46 and the data request referred to in Article 47. Those implementing acts shall be adopted in accordance with the procedure referred to in Article 68(2).

RemovedArticle 46 – paragraph 1: 1. Health data access bodies shall issue a data permit only when, after an assessment of the data access application, they find that it fulfils all of the following criteria: / (a) the purpose described in the health data access application is one of the purposes listed in Article 34(1); / (b) the requested data is necessary, adequate and proportionate for the purpose or purposes listed in the health data access application; / (c) in the case of pseudonomised data, there is sufficient justification that the purpose cannot be achieved with anonymised data; / (d) the processing complies with Article 6(1) and Article 9(2) of Regulation (EU) 2016/679 in the case of access to pseudonymised electronic health data; / (e) the health data applicant demonstrates sufficient technical and organisational measures to prevent any other use or misuse of the electronic health data and to protect the rights and interests of the data holder and of the natural persons concerned; / (f) the information on the assessment of ethical aspects of the processing, where applicable, is in line with national law; / (g) all other requirements in this Chapter are fulfilled by the health data applicant.

RemovedArticle 46 – paragraph 2: 2. Health data access bodies shall refuse all applications where requirements in this Chapter are not met.

RemovedArticle 46 – paragraph 3: 3. After the health data applicant has demonstrated the effective implementation of their security measures referred to in Article 45(2), points (e) and (f), the health data access body shall issue or refuse a data permit within 2 months of receiving a complete data access application. If the health data access body finds that the data access application is incomplete, it shall notify the health data applicant, who shall be given the possibility of completing their application. If the health data applicant does not fulfil this request within four weeks, a permit shall not be granted. By way of derogation from that Regulation (EU) 2022/868 the health data access body may extend the period for responding to a data access application by 2 additional months where necessary, taking into account the complexity of the request. In such cases, the health data access body shall notify the applicant as soon as possible that more time is needed for examining the application, together with the reasons for the delay.

RemovedArticle 46 – paragraph 4: 4. Following the issuance of the data permit, the health data access body shall immediately request the electronic health data from the data holder and inform them whether the data will be made accessible in anonymised or pseudonymised form. The health data access body shall make available the electronic health data to the health data user within 2 months after receiving them from the data holders.

RemovedArticle 46 – paragraph 5: 5. When the health data access body refuses to issue a data permit, it shall provide a justification for the refusal to the health data applicant.

RemovedArticle 46 – paragraph 6 – introductory part: 6. The data permit shall set out the general conditions applicable to the health data user, in particular:

RemovedArticle 46 – paragraph 6 – point a: (a) categories and format of electronic health data accessed, covered by the data permit, including their sources;

RemovedArticle 46 – paragraph 6 – point b: (b) a detailed description of the purpose for which data are made available;

RemovedArticle 46 – paragraph 6 – point b a (new): (ba) the identity of the user as well as the concrete persons who are authorised to have access to the electronic health data in the secure processing environment;

RemovedArticle 46 – paragraph 6 – point d: (d) information about the technical characteristics and tools available to the health data user within the secure processing environment;

RemovedArticle 46 – paragraph 6 – point e: (e) fees to be paid by the health data user;

RemovedArticle 46 – paragraph 7: 7. Data users shall have the right to access and process the electronic health data in a secure processing environment in accordance with the data permit delivered to them on the basis of this Regulation.

RemovedArticle 46 – paragraph 8: 8. The Commission is empowered to adopt delegated acts to amend the list of aspects to be covered by a data permit in paragraph 6 of this Article, in accordance with the procedure set out in Article 67.

RemovedArticle 46 – paragraph 9: 9. A data permit shall be issued for the duration necessary to fulfil the requested purposes which shall not exceed 5 years. This duration may be extended once, at the request of the data user, based on arguments and documents to justify this extension provided, 1 month before the expiry of the data permit, for a period which cannot exceed 5 years. By way of derogation from Article 42, the health data access body may charge increasing fees to reflect the costs and risks of storing electronic health data for a longer period of time exceeding the initial 5 years. In order to reduce such costs and fees, the health data access body may also propose to the data user to store the dataset in storage system with reduced capabilities. The data within the secure processing environment shall be deleted without undue delay following the expiry of the data permit. Upon request of the data user, the formula on the creation of the requested dataset shall be stored by the health data access body.

RemovedArticle 46 – paragraph 11: deleted

RemovedArticle 46 – paragraph 12: deleted

RemovedArticle 46 – paragraph 14: 14. The liability of health data access bodies as controller is limited to the scope of the issued data permit until the completion of the processing activity and in accordance with Article 51.

RemovedArticle 47 – title: Health data request

RemovedArticle 47 – paragraph 1: 1. The health data applicant may submit a health data request for the purposes referred to in Article 34 with the aim of obtaining an answer only in anonymised or aggregated statistical format. A health data access body shall not provide an answer to a health data request in any other format and the health data user shall have no access to the electronic health data used to provide this answer.

RemovedArticle 47 – paragraph 2 – introductory part: 2. A health data request shall include the elements mentioned in paragraphs 2 (a) and (b) of Article 45 and if needed may also include:

RemovedArticle 47 – paragraph 3: 3. The health data access body shall assess the health data request, within 2 months and, where possible, provide the result to the health data user within 2 months.

RemovedArticle 48 – title: Making data available, without a data permit, for public sector bodies and Union institutions, bodies, offices and agencies with a legal mandate in the field of public health

RemovedArticle 48 – paragraph 1: By derogation from Article 46 of this Regulation, a health data permit shall not be required to access the electronic health data under this Article. When carrying out those tasks under Article 37 (1), points (b) and (c), the health data access body shall inform public sector bodies and Union institutions, offices, agencies and bodies with a legal mandate in the field of public health, about the availability of data within 2 months of the data access application, in accordance with Article 9 of Regulation […] [Data Governance Act COM/2020/767 final]. By way of derogation from that Regulation […] [Data Governance Act COM/2020/767 final ], the health data access body may extend the period by 2 additional months where necessary, taking into account the complexity of the request. The health data access body shall make available the electronic health data to the health data user within 2 months after receiving them from the health data holders, unless it specifies that it will provide the data within a longer specified timeframe. Articles 43 and 43a shall be applicable to the situations covered under this Article.

RemovedArticle 49: deleted / (deleted) / (deleted) / (deleted) / (deleted) / (deleted)

RemovedArticle 50 – paragraph 1 – introductory part: 1. The health data access bodies shall provide access to electronic health data pursuant to a data permit only through a secure processing environment, with technical and organisational measures and security and interoperability requirements. In particular, they shall take the following security measures:

RemovedArticle 50 – paragraph 1 – point b: (b) minimise the risk of the unauthorised reading, copying, modification or removal of electronic health data hosted in the secure processing environment through state-of-the-art technical and organisational measures;

RemovedArticle 50 – paragraph 1 – point d: (d) ensure that health data users have access only to the electronic health data covered by their data permit, by means of individual and unique user identities and confidential access modes only;

RemovedArticle 50 – paragraph 1 – point e: (e) keep identifiable logs of access to the secure processing environment for the period of time necessary to verify and audit all processing operations in that environment, and in any event for not shorter than one year;

RemovedArticle 50 – paragraph 1 – point f a (new): (fa) ensure that the secure processing environment is located within the Union.

RemovedArticle 50 – paragraph 2: 2. The health data access bodies shall ensure that electronic health data from health data holders in the format determined by the data permit can be uploaded by health data holders and can be accessed by the health data user in a secure processing environment. The health data users shall only be able to download or copy non-personal electronic health data from the secure processing environment, in accordance with Article 37.

RemovedArticle 50 – paragraph 3: 3. The health data access bodies shall ensure regular audits, including by third parties, of the secure processing environments and take immediate corrective action for any shortcomings, risks or vulnerabilities identified in the secure processing environments.

RemovedArticle 50 – paragraph 4: 4. The Commission shall, by means of implementing acts, provide for the technical, organisational, information security, confidentiality, data protection and interoperability requirements for the secure processing environments, after having consulted with ENISA. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 51 – title: Controllership

RemovedArticle 51 – paragraph 1: 1. The health data holder shall be deemed controller for data made available to the health data access body pursuant to Article 41(1) and (1a) of this Regulation. The health data access body shall be deemed controller for the processing of the personal electronic health data when fulfilling its tasks pursuant to Article 37(1), point (d), of this Regulation. The health data user shall be deemed controller for the processing of personal electronic health data in pseudonymised form in the secure processing environment pursuant to its data permit. The health data access body shall act as a processor for the processing by the health data user pursuant to a data permit in the secure processing environment.

RemovedArticle 52 – paragraph 3: 3. Union institutions, bodies, offices and agencies involved in health research, health policy or analysis, shall be authorised participants of HealthData@EU.

RemovedArticle 52 – paragraph 5: 5. Third countries or international organisations may become authorised participants where they comply with the rules of Chapter IV of this Regulation, where the transfer stemming from such connection complies with the rules in Chapter V of Regulation (EU) 2016/679 and Article 63a of this Regulation and where provide access to data users located in the Union, on equivalent terms and conditions, to the electronic health data available to their health data access bodies. The Commission may adopt implementing acts establishing that a national contact point of a third country or a system established at an international level is compliant with requirements of HealthData@EU for the purposes of secondary use of health data, is compliant with the Chapter IV of this Regulation and Chapter V of Regulation (EU) 2016/679 and provides access to data users located in the Union to the electronic health data it has access to on equivalent terms and conditions. The compliance with these legal, organisational, technical and security requirements, including with the standards for secure processing environments pursuant to Article 50 shall be checked under the control of the Commission. These implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2). The Commission shall make the list of implementing acts adopted pursuant to this paragraph publicly available.

RemovedArticle 52 – paragraph 12: 12. Member States and the Commission shall seek to ensure interoperability of HealthData@EU with other relevant common European data spaces as referred to in Regulations (EU) 2022/868 and […] [Data Act COM/2022/68 final].

RemovedArticle 52 – paragraph 13 – subparagraph 1 – introductory part: The Commission shall, by means of delegated acts, set out:

RemovedArticle 52 – paragraph 13 – subparagraph 1 – point a: (a) requirements, technical specifications, the IT architecture of HealthData@EU, which shall ensure state-of-the-art data security, confidentiality, and protection of electronic health data in the cross border infrastructure;

RemovedArticle 52 – paragraph 13 – subparagraph 1 – point a a (new): (aa) conditions and compliance checks for authorised participants to join and remain connected to HealthData@EU and conditions for temporary or definitive exclusion from HealthData@EU, including specific provisions for cases of serious misconduct or repeated violation;

RemovedArticle 52 – paragraph 13 – subparagraph 2: The Commission shall consult with the ENISA in the drawing up of the delegated act.

RemovedArticle 53 – title: Access to cross-border registries and databases for secondary use

RemovedArticle 54 – title: Cross-border access to and mutual recognition of data permits

RemovedArticle 54 – paragraph 1: 1. When handling an access application for cross-border access to electronic health data for secondary use, health data access bodies and relevant authorised participants shall remain responsible for taking decisions to grant or refuse access to electronic health data within their remit in accordance with the requirements for access laid down in this Chapter. After a decision has been made regarding the granting or refusal of the health data permit, the health data access body shall inform the other health data bodies concerned by the same application about the decision.

RemovedArticle 55 – title: Dataset description and dataset catalogue

RemovedArticle 56 – paragraph 2 a (new): 2a. The health data access body shall assess whether the data meets the requirements in paragraph 3 and shall revoke the label in the event the data does not meet the required quality.

RemovedArticle 56 – paragraph 3 – introductory part: 3. The data quality and utility label shall cover the following elements:

RemovedArticle 57 – paragraph 1: 1. The Commission shall establish an EU Datasets Catalogue connecting the national catalogues of datasets established by the health data access bodies and other authorised participants in HealthData@EU taking into consideration the health interoperability resources already developed across the Union.

RemovedArticle 59 – paragraph 1: The Commission shall support sharing of best practices and expertise, aimed to build the capacity of Member States to strengthen digital health systems for primary and secondary use of electronic health data. To support capacity building, the Commission shall draw up benchmarking guidelines for the primary and secondary use of electronic health data. The Commission shall issue guidance with regard to compliance of data holders with the provisions of Chapter IV, taking into account the specific conditions of data holders that are civil society, researchers, medical societies and SMEs.

RemovedArticle 59 a (new): Article 59a / Digital health literacy and digital health access / 1. In order to ensure successful implementation of the EHDS, Member States shall support digital health literacy, promote public awareness, including through educational programmes for natural persons, health professionals and stakeholders, to inform the public of the rights and obligations in the EHDS and inform natural persons of the advantages, risks and potential gains to science and society of the primary and secondary use of electronic health data, and offer free of charge accessible training to health professionals in this regard. Those programmes shall be tailored to the needs of specific groups and shall be developed and reviewed, and where necessary updated, on a regular basis in consultation and cooperation with relevant experts and stakeholders. / The Commission shall support Member States in this regard. / 2. Member States shall monitor and evaluate, on a regular basis, the digital health literacy of health professionals and natural persons, in particular about the primary and secondary use of health data, functionalities and conditions as well as rights of natural persons within the EHDS. / 3. Member States shall promote the access to the infrastructure necessary for the effective management of natural persons’ electronic health data, both within primary and secondary use. / 4. Member States shall regularly inform the public at large about the role and benefits of the secondary use of health data …

RemovedArticle 60 – paragraph 2 a (new): 2a. Public procurers, national competent authorities, including digital health authorities and health data access bodies, and the Commission shall require, as a condition to procure or fund services provided by controllers and processors established in the Union processing personal electronic health data, that such controllers and processors: / (a) store those data in the Union, in accordance with Article 60a of this Chapter: and / (b) have duly demonstrated that they are not subject to third country law conflicting with Union data protection rules.

RemovedArticle 60 a (new): Article 60a / Storage of personal electronic health data / For the purposes of primary and secondary use of personal electronic health data, the storage of personal electronic health data shall exclusively take place within the territory of the Union, without prejudice to the provisions of Article 63.

RemovedArticle 61 – title: Sensitive nature of non-personal electronic health data

RemovedArticle 61 – paragraph 1: 1. Non-personal electronic health data made available by health data access bodies, that are based on a natural person’s electronic data falling within one of the categories of Article 33 shall be deemed highly sensitive within the meaning of Article 5(13) of Regulation […] [Data Governance Act COM/2020/767 final].

RemovedArticle 61 – paragraph 2: 2. The protective measures for the categories of data mentioned in paragraph 1 shall be detailed in the Delegated Act under the empowerment set out in Article 5(13) of Regulation (EU) 2022/868.

RemovedArticle 63 – paragraph 1: International access and transfer of personal electronic health data shall be granted in accordance with Chapter V of Regulation (EU) 2016/679. Member States may maintain or introduce further conditions on international access to, and transfer of, personal electronic health data, including limitations, in accordance with and under the conditions of article 9(4) of the Regulation (EU) 2016/679.

RemovedArticle 63 a (new): Article 63a / Reciprocity of access to electronic health data for secondary use / 1. Notwithstanding Articles 62 and 63, only entities and bodies that are established in third countries included in the list referred to in paragraph 2 shall be allowed access to electronic health data in the secure processing environment and have the possibility of downloading non-personal electronic health data held in the Union for the purposes of secondary use. / 2. The Commission is empowered to adopt delegated acts in accordance with Article 67 supplementing this Regulation by setting up a list of third countries which are considered to provide for equivalent access to, and transfer of, electronic health data of its data holders for the purposes of secondary use of electronic health data by entities and bodies within the Union. / 3. The Commission shall monitor the list of third countries benefiting from such access, and shall provide for a periodic review of the functioning of this Article. / 4. Where the Commission considers that a third country no longer meets the requirement to be included on the list referred to in paragraph 2, it shall adopt a delegated act to remove such third country that benefits from access.

RemovedArticle 64 – paragraph 1: 1. A European Health Data Space Board (EHDS Board) is hereby established to facilitate cooperation and the exchange of information among Member States. The EHDS Board shall be composed of, one high level representative of digital health authorities and one high level representative of health data access bodies per Member State appointed by the Member State concerned. Where a Member State has designated several health data access bodies, the representative of the coordinating health data access body shall be a member of the EHDS Board; / Other national authorities, including market surveillance authorities referred to in Article 28, European Data Protection Board and European Data Protection Supervisor and Union agencies within the field of public health and cybersecurity shall also be invited to the meetings, where the issues discussed are of relevance for them. The Board may invite stakeholders, experts and observers to attend its meetings, and may cooperate with other external experts as appropriate. Other Union institutions, bodies, offices and agencies, research infrastructures and other similar structures may have an observer role. The EHDS Board shall invite a representative of the European Parliament to attend its meetings as an observer.

RemovedArticle 64 – paragraph 2: Members of the EHDS Board shall not have financial or other interests in industries or economic activities which could affect their impartiality. They shall undertake to act in the public interest and in an independent manner, and shall make an annual declaration of their financial interests. All indirect interests which could relate to such industries or economic activities shall be entered in a register held by the Commission which is accessible to the public, upon request, at the Commission’s offices. / The EHDS Board’s code of conduct shall make reference to the application of this Article, in particular in relation to the acceptance of gifts.

RemovedArticle 64 – paragraph 3: 3. The EHDS Board shall adopt rules of procedure and a code of conduct, following a proposal from the Commission. Those rules of procedure shall provide for the composition, organisation, functioning and cooperation of the Board and its cooperation with the Advisory Board.

RemovedArticle 64 – paragraph 4: deleted

RemovedArticle 64 – paragraph 5: 5. The EHDS Board shall cooperate with other relevant bodies, entities and experts, such as the European Data Innovation Board referred to in Article 26 of Regulation […] [Data Governance Act COM/2020/767 final], competent bodies set up under Article 7 of Regulation […] [Data Act COM/2022/68 final], supervisory bodies set up under Article 17 of Regulation […] [eID Regulation], European Data Protection Board referred to in Article 68 of Regulation (EU) 2016/679 and cybersecurity bodies, in particular the ENISA.

RemovedArticle 64 – paragraph 7 a (new): 7a. The EHDS Board shall publish meeting dates and minutes of the discussions and publish an annual report on its activities.

RemovedArticle 64 – paragraph 8: 8. The Commission shall, by means of implementing acts, adopt the necessary measures for the establishment and operations of the EHDS Board. Those implementing acts shall be adopted in accordance with the advisory procedure referred to in Article 68(2).

RemovedArticle 64 a (new): Article 64a / Advisory forum / 1. An advisory forum to advise the EHDS Board in the fulfilment of its tasks by providing stakeholder input in matters covered by this Regulation is hereby established. / 2. The advisory forum shall be composed of relevant stakeholders, including representatives of patients’ organisations, health professionals, industry, consumer organisations, scientific researchers and academia. The advisory forum shall have a balanced composition and represent the views of different relevant stakeholders. / Where commercial interests are represented in the advisory forum, they shall be balanced between large companies, SMEs and start-ups. Focus on primary and secondary use of electronic health data shall also be balanced. / 3. Members of the advisory forum shall be appointed by the Commission following a public call for interest and a transparent selection procedure, in consultation with the European Parliament. Members of the advisory forum shall make an annual declaration of their interests, which shall be updated whenever relevant and shall be made publicly available. / 4. The term of office of the members of the advisory forum shall be two years and it shall be renewable only once consecutively. / 5. The advisory forum may establish standing or temporary subgroups as appropriate for the purpose of examining specific questions related to the objectives of this Regulation. / 6. The advisory forum shall draw up its rules of procedure and elect one co-chair f…

RemovedArticle 65 – paragraph -1 (new): -1. The EHDS Board shall promote the consistent application of this Regulation.

RemovedArticle 65 – paragraph 1 – point b – introductory part: (b) to issue written contributions and to exchange best practices on matters related to the coordination of the implementation at Member State level of this Regulation and of the delegated and implementing acts adopted pursuant to it, taking into account the regional and local level, in particular as regards:

RemovedArticle 65 – paragraph 1 – point b – point iii: (iii) other aspects of the primary use of electronic health data without prejudice to the powers of the supervisory authorities pursuant to Regulation (EU) 2016/679; the written contributions of the EHDS board shall not concern the interpretation or application of rights and obligations under Regulation (EU) 2016/679 or Regulation (EU) 2018/1725.

RemovedArticle 65 – paragraph 1 – point b a (new): (ba) to provide guidance and recommendations to digital health authorities;

RemovedArticle 65 – paragraph 1 – point d: (d) to share among the Members of the Board information concerning risks posed by EHR systems and serious incidents as well as their handling, without prejudice to the obligation to inform competent supervisory authorities pursuant to Regulation (EU) 2016/679;

RemovedArticle 65 – paragraph 1 – point e: (e) to facilitate the exchange of views on the primary use of electronic health data with the Advisory Forum referred to in Article 64(a), regulators and policy makers in the health sector to support the design of aligned implementation strategies, guidance and standards and to assess the needs for further improvement. In addition, the co-chairs of the advisory forum shall be invited at least once annually to a meeting of the EHDS Board to present its activities.

RemovedArticle 65 – paragraph 2 – point b – point v: deleted

RemovedArticle 65 – paragraph 2 – point b – point vi: (vi) other aspects of the secondary use of electronic health data without prejudice to the powers of the supervisory authorities pursuant to Regulation (EU) 2016/679.

RemovedArticle 65 – paragraph 2 – point c: (c) to facilitate cooperation and exchange of best practices between health data access bodies through capacity-building, establishing the structure for annual activity reporting, peer-review of annual activity reports and exchange of information pursuant to the obligations laid down in Article 37(1), point (q);

RemovedArticle 65 – paragraph 2 – point d: (d) to share information concerning risks and data protection incidents related to secondary use of electronic health data, as well as their handling; without prejudice to the obligation to inform competent supervisory authorities pursuant to Regulation (EU) 2016/679;

RemovedArticle 65 – paragraph 2 – point f: (f) to exchange views on the secondary use of electronic health data with the Advisory Forum referred to in Article 64(a) regulators and policy makers in the health sector, to support the design of aligned implementation strategies, guidance and standards and to assess the needs for further improvement;

RemovedArticle 65 – paragraph 2 – point f a (new): (fa) adopt recommendations to facilitate consistent provision of the secure processing environment compliant with the technical, information security and interoperability requirements.

RemovedArticle 65 – paragraph 2 a (new): 2a. The EHDS board shall provide recommendations to the Commission and the Member States on the implementation and enforcement of this Regulation, including cross-border interoperability of health data, and potential mechanisms of funding support to ensure equal development of health data systems across Europe in respect of the secondary use of electronic health data, without prejudice to the competences of the EDPB, where personal electronic health data are concerned;

RemovedArticle 65 – paragraph 2 b (new): 2b. The EHDS board may commission studies and other initiatives in order to support the implementation and development of the EHDS.

RemovedArticle 65 – paragraph 2 c (new): 2c. The EHDS Board shall publish an annual report to include the implementation status of the EHDS and other relevant points of development, including with respect to cross-border health data interoperability, and related implementation challenges.

RemovedArticle 66 – paragraph 3: 3. Stakeholders and relevant third parties, including patients’, health professionals’, consumers’ and industry representatives, may be invited to attend meetings of the groups and to participate in their work.

RemovedArticle 66 – paragraph 6 a (new): 6a. The groups shall consult relevant experts when carrying out their tasks, as well as on technical implementing measures related to cybersecurity, confidentiality and data protection, in particular experts from ENISA, EDPB and EDPS.

RemovedArticle 67 – paragraph 2: 2. The power to adopt delegated acts referred to in Articles 5(2), 7(3), 9(2) 10(3), 13(3) 25(3), 32(4), 37(4), 39(3), 41(7), 45(7), 46(8), 52(7), 52(13), 56(4) and 63a(2) shall be conferred on the Commission for an indeterminate period of time from the date of entry into force of this Regulation.

RemovedArticle 67 – paragraph 3: 3. The power to adopt delegated acts referred to in Articles 5(2), 7(3) 37(4), 39(3), 41(7), 45(7), 46(8), 52(7), 52(13), 56(4) and 63a(2) may be revoked at any time by the European Parliament or by the Council. A decision to revoke shall put an end to the delegation of the power specified in that decision. It shall take effect the day following the publication of the decision in the Official Journal of the European Union or at a later date specified therein. It shall not affect the validity of any delegated acts already in force.

RemovedArticle 67 – paragraph 6: 6. A delegated act adopted pursuant to Articles 5(2), 7(3), 9(2), 13(3), 25(3), 32(4), 37(4), 39(3), 41(7), 45(7), 46(8), 52(7), 52(13), 56(4) or 63a(2) shall enter into force only if no objection has been expressed either by the European Parliament or by the Council within a period of 3 months of notification of that act to the European Parliament and to the Council or if, before the expiry of that period, the European Parliament and the Council have both informed the Commission that they will not object. That period shall be extended by 3 months at the initiative of the European Parliament or of the Council.

RemovedArticle 68 – paragraph 2 a (new): 2a. Where reference is made to this paragraph, Article 5 of Regulation (EU) No 182/2011 shall apply.

RemovedArticle 69 – paragraph 1: Member States shall lay down the rules on other penalties applicable to infringements of this Regulation in particular for infringements which are not subject to administrative fines pursuant to Article 43a, and shall take all measures necessary to ensure that they are implemented. The penalties shall be effective, proportionate and dissuasive. Member States shall notify the Commission of those rules and measures by date of application of this Regulation and shall notify the Commission without delay of any subsequent amendment affecting them.

RemovedArticle 69 a (new): Article 69a / Right to receive compensation / Any person who has suffered material or non-material damage as a result of an infringement of this Regulation shall have the right to receive compensation, in accordance with national and Union law.

RemovedArticle 69 b (new): Article 69b / Representation of a natural person / Where a natural person considers that their rights under this Regulation have been infringed, they shall have the right to mandate a not-for-profit body, organisation or association which is constituted in accordance with the law of a Member State, has statutory objectives which are in the public interest and is active in the field of the protection of personal data, to lodge a complaint on their behalf or to exercise the rights referred to in Article 11a.

RemovedArticle 69 c (new): Article 69c / Suspension of proceedings / 1. Where a competent court of a Member State seised of proceedings against a decision by a digital health authority or health data access body has reason to believe that proceedings concerning the same access to electronic health data by the same health data user, such as for the same purpose of processing for secondary use are brought before a competent court in another Member State, it shall contact that court in order to confirm the existence of such related proceedings. / 2. Where proceedings concerning the same subject matter and the same digital health authority or health data access body are pending before a court in another Member State, any court other than the court first seised may stay its proceedings or may, at the request of one of the parties, decline jurisdiction in favour of the court first seised if that court has jurisdiction over the proceedings in question and its law permits the consolidation of such related proceedings.

RemovedArticle 70 – paragraph 1: 1. By 5 years from the entry into force of this Regulation, the Commission shall carry out a targeted evaluation of this Regulation especially with regards to the possibilities to further extend interoperability between EHR systems and electronic health data access services other than those established by the Member States, the possibility of expanding the access to MyHealth@EU infrastructure to third countries and international organisations, the need to update the data categories in Article 33 and the purposes of use in Article 34, the implementation and use by natural persons of the opt-out mechanism in secondary use as referred to in Article 33(5a), and opt-in mechanism in secondary use as referred to in Article 33(5b), the use and implementation of the right referred to in Article 3(9), as well as the application of fees as referred to in Article 42 and submit a report on its main findings to the European Parliament and to the Council, the European Economic and Social Committee and the Committee of the Regions, accompanied, where appropriate, by a proposal for its amendment.

RemovedArticle 70 – paragraph 1 a (new): 1a. By ... [please insert the date two years from the entry into force of this Regulation], the Commission shall carry out an evaluation of the Union funding attributed to the setting up and functioning of the EHDS, in particular concerning the ability of the bodies established under this Regulation to carry out their tasks and obligations under this Regulation and of Member States in relation to applying the Regulation in a uniform and coherent manner. The Commission shall submit a report on its main findings to the European Parliament and to the Council, the European Economic and Social Committee and the Committee of the Regions, accompanied, where appropriate, by the necessary measures.

RemovedArticle 70 – paragraph 2: 2. After 7 years from the entry into force of this Regulation, the Commission shall carry out an overall evaluation of this Regulation, and submit a report on its main findings to the European Parliament and to the Council, the European Economic and Social Committee and the Committee of the Regions, accompanied, where appropriate, by a proposal for its amendment or other appropriate measures.

RemovedArticle 71 a (new): Article 71a / Amendments to Directive (EU) 2020/1828 / In the Annex to Directive (EU) 2020/1828, the following point is added: / (XX) Regulation (EU) XXX of the European Parliament and of the Council on the European Health Data Space.

RemovedArticle 72 – paragraph 2: It shall apply from 24 months after its entry into force.

RemovedArticle 72 – paragraph 3 – point b: (b) from 3 years after date of entry into application to categories of personal electronic health data referred to in Article 5(1), points (d), (e) (f), and (fa) and to EHR systems intended by the manufacturer to process such categories of data;

RemovedArticle 72 – paragraph 3 – point c: deleted

RemovedAnnex II – point 2 – point 2.3: 2.3. An EHR system that includes a functionality for entering structured personal electronic health data shall enable the entry of data structured in a structured way that supports the data sharing in a structured, commonly used, open and machine-readable format, enabling system to system communication.

RemovedAnnex II – point 2 – point 2.5: 2.5. An EHR system shall not include features that prohibit, restrict or place undue burden on authorised exporting of personal electronic health data for the reasons of replacing the EHR system by another product. Authorised exporting of personal electronic health data shall be free of charge, without undue delay, or in in any event within one month from the request and in a structured, commonly used and machine-readable format, in line with the interoperability and security requirements to be developed according to Articles 23 and 50.

RemovedAnnex II – point 2 – point 2.5 a (new): 2.5a. An EHR system shall be developed in interoperable format that enables data portability.

RemovedAnnex II – point 3 – point 3.1: 3.1. An EHR system shall be designed and developed in such a way that it ensures highly safe and secure processing of electronic health data, and that it prevents unauthorised access to such data.

RemovedAnnex II – point 3 – point 3.1: 3.1. An EHR system shall be designed and developed in such a way that it ensures safe and secure processing of electronic health data, and that it prevents unauthorised access to such data, and that it duly takes into consideration the principles of data minimisation and data protection by design.

RemovedAnnex II – point 3 – point 3.8: 3.8. An EHR system designed for the storage of electronic health data shall support different retention periods and access rights that take into account the origins and categories of electronic health data as well as the specific purposes of data processing.

RemovedAnnex IV a (new): ANNEX IVa / 1. EU type-examination is the part of a conformity assessment procedure in which a notified body examines the technical design of an EHR system and verifies and attests that the technical design of the EHR system meets the applicable requirements of this Regulation. / 2. EU type-examination shall be carried out by assessment of the adequacy of the technical design of the EHR system through examination of the technical documentation, plus examination of a specimen of the EHR system that is representative of the production envisaged (production type). / 3. Application for EU type-examination / The manufacturer shall lodge an application for EU type-examination with a single notified body of his or her choice. The application shall include: / (a) the name and address of the manufacturer and, if the application is lodged by an authorised representative, the name and address of that authorised representative; / (b) a written declaration that the same application has not been lodged with any other notified body; / (c) the technical documentation described in Annex III; / (d) the specimen(s) of the EHR system representative of the production envisaged. The notified body may request further specimens if needed for carrying out the test programme. / 4. EU type-examination / The notified body shall: / (a) examine the technical documentation to assess the adequacy of the technical design of the EHR system; / (b) verify that the EHR system has been manufactured in conformity …