Advancing Real-World Evidence Through a Federated Health Data Network (EHDEN): Descriptive Study

Real-world data (RWD) are increasingly used in health research and regulatory decision-making to assess the effectiveness, safety, and value of interventions in routine care. However, the heterogeneity of European health care systems, data capture methods, coding standards, and governance structures poses challenges for generating robust and reproducible real-world evidence. The European Health Data & Evidence Network (EHDEN) was established to address these challenges by building a large-scale federated data infrastructure that harmonizes RWD across Europe.

This study aims to describe the composition and characteristics of the databases harmonized within EHDEN as of September 2024. We seek to provide transparency regarding the types of RWD available and their potential to support collaborative research and regulatory use.

EHDEN recruited data partners through structured open calls. Selected data partners received funding and technical support to harmonize their data to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM), with assistance from certified small-to-medium enterprises trained through the EHDEN Academy. Each data source underwent an extract-transform-load process and data quality assessment using the data quality dashboard. Metadata-including country, care setting, capture method, and population criteria-were compiled in the publicly accessible EHDEN Portal.

As of September 1, 2024, the EHDEN Portal includes 210 harmonized data sources from 30 countries. The highest representation comes from Italy (13%), Great Britain (12.5%), and Spain (11.5%). The mean number of persons per data source is 2,147,161, with a median of 457,664 individuals. Regarding care setting, 46.7% (n=98) of data sources reflect data exclusively from secondary care, 42.4% (n=89) from mixed care settings (both primary and secondary), and 11% (n=23) from primary care only. In terms of population inclusion criteria, 55.7% (n=117) of data sources include individuals based on health care encounters, 32.9% (n=69) through disease-specific data collection, and 11.4% (n=24) via population-based sources. Data capture methods also vary, with electronic health records (EHRs) being the most common. A total of 74.7% (n=157) of data sources use EHRs, and more than half of those (n=85) rely on EHRs as their sole method of data collection. Laboratory data are used in 29.5% (n=62) of data sources, although only one relies exclusively on laboratory data. Most laboratory-based data sources combine this method with other forms of data capture.

EHDEN is the largest federated health data network in Europe, enabling standardized, General Data Protection Regulation-compliant analysis of RWD across diverse care settings and populations. This descriptive summary of the network's data sources enhances transparency and supports broader efforts to scale federated research. These findings demonstrate EHDEN's potential to enable collaborative studies and generate trusted evidence for public health and regulatory purposes.