Despite significant investment in digital health infrastructure, a gap between technology and the skills to use it persists across the EU.
Europe has spent the better part of a decade building digital health infrastructure — interoperable patient records, telemedicine platforms, national eHealth portals. The architecture is increasingly in place. The problem, as a growing body of evidence makes clear, is that neither the citizens these systems serve nor the clinicians operating them always have the skills to use them effectively.
Between 30 and 70 percent of health workers across the EU report lacking some of the digital competencies required to engage fully with health information technology, according to data compiled across OECD member states. On the citizen side, figures from the Commission’s Digital Decade 2025 eHealth Indicator Study point to persistent gaps in basic eHealth literacy, particularly among older age groups and residents of rural regions. The disparity is not merely inconvenient — it undermines the return on public investment and, more directly, patient outcomes.
A Two-Sided Deficit
The digital health skills gap manifests along two distinct but related dimensions: the professional workforce and the general population.
For physicians, nurses, and allied health workers, the challenge is one of pace. Electronic health records, clinical decision-support tools, and remote monitoring platforms have been rolled out faster than training curricula have adapted. In many member states, digital health competencies are still treated as supplementary skills rather than core professional requirements. Pre-service education — medical and nursing school curricula — has been slow to incorporate structured digital literacy components.
On the patient side, the picture is complicated by demographic and geographic factors. OECD data from Health at a Glance: Europe 2024 show that digital health literacy rates among primary care users over the age of 45 are substantially lower than in younger cohorts. Among those with lower educational attainment, the score was 18 percent, compared with 26 percent among the higher educated. Country-level variation is equally striking: in Czechia, 53 percent of highly educated patients reported adequate digital health literacy; in Italy, the figure was just 9 percent, falling further among those with less formal education.
These are not simply technology adoption problems. They reflect structural inequalities in digital access and education that digital health policy, on its own, cannot resolve.
What the EU Policy Framework Offers
The European Commission’s Digital Education Action Plan 2021–2027 provides the broadest policy framework for addressing digital skills across the Union. Its second strategic priority — developing digital competences and skills — explicitly covers the health sector, calling on member states to integrate digital literacy into education at all levels. In April 2023, the Commission adopted two Council Recommendations: one on enabling factors for digital education, another on improving digital skills provision. Both were adopted by the Council in November 2023.
Separately, the eHealth Network — a voluntary body connecting national authorities designated by member states — has worked to define interoperability standards and issue guidance on cross-border health data exchange. Its mandate, however, is primarily technical. The Network issues non-binding guidelines; it does not set training standards or fund workforce development directly.
The WHO Global Strategy on Digital Health 2020–2025 (extended to 2027 by World Health Assembly resolution WHA78(22) in May 2025) sets out a complementary framework at the international level. It calls explicitly for integrating digital health competencies into pre-service and in-service training for all health professionals and allied workers, and for capacity-building that spans clinical skills, strategic planning, and governance. The strategy’s emphasis on leadership capacity — training health administrators to make informed digital investment decisions — addresses a blind spot that purely technical curricula tend to overlook.
Taken together, these frameworks create a policy scaffolding. What they have not yet produced is consistent implementation across 27 member states operating under different education systems, health sector governance structures, and fiscal constraints.
Estonia as a Reference Point — and Its Limits
Any discussion of digital health progress in Europe eventually reaches Estonia. The country ranks first in the EU on the Commission’s eHealth Index, achieved the Digital Decade 2030 eHealth target in 2024 ahead of schedule, and maintains a health system in which 99 percent of health data is fully digitised. A unified patient record has existed for every citizen since 2008. Digital prescriptions have been standard since 2010.
Estonia’s advantage, however, is not simply a matter of technology investment. It reflects a long-standing national commitment to digital governance that permeates public administration broadly, with digital literacy integrated into compulsory education from an early stage. The country’s small size — a population of approximately 1.4 million — has also enabled coherent nationwide rollout of systems that would face substantial coordination challenges in larger federal or regionally fragmented states.
The Netherlands and the Nordic countries are also consistently among the top performers in European eHealth adoption metrics. The common thread is not any single technology, but institutional continuity: sustained investment, clear data governance, and training systems that kept pace with infrastructure deployment.
For lagging member states — where infrastructure rollout has outpaced skills development, or where rural and elderly populations remain effectively excluded from digital health services — the Estonian model offers directional guidance rather than a directly transplantable blueprint. The political capital required to replicate that governance approach across diverse national contexts remains a significant obstacle.
Barriers That Policy Alone Cannot Bridge
Infrastructure remains an unresolved constraint in parts of the EU. Reliable high-speed internet access — a prerequisite for telehealth and patient portal use — is not uniformly available in rural and peripheral regions. Where connectivity is poor, digital health tools are inaccessible regardless of literacy levels.
Age is a recurring variable in utilisation data. Older patients, who also tend to have higher healthcare needs, are consistently among the least likely to use eHealth services. Designing digital tools with accessibility in mind — larger interfaces, simplified navigation, multilingual support — partially addresses this, but does not substitute for digital skills training tailored to older cohorts.
In the health workforce, a structural barrier operates at the institutional level. Continuing professional development budgets in many member states are inadequate to fund meaningful digital upskilling at scale. Time constraints in overburdened health systems compound this: even where training is available, clinicians may lack the protected working time to complete it.
The development of the European Health Data Space will place additional demands on both professional and patient digital literacy. Navigating cross-border health data flows, understanding consent frameworks, and making informed choices about data sharing presupposes competencies that much of the EU population does not currently have. The ambition of the EHDS and the reality of skills distribution across member states are not currently aligned.
What a Coherent Policy Response Would Require
Several interventions emerge consistently from the evidence as necessary components of a meaningful response.
Curriculum integration: Digital health literacy needs to become a mandatory component of pre-service training for all health professions — not an elective or a postgraduate add-on. Medical and nursing schools across the EU currently vary widely in how much, if any, structured digital competency training they include. A common minimum standard, developed through the eHealth Network and incorporated into national accreditation frameworks, would begin to address this at scale.
In-service training with protected time: Pre-service reform alone reaches only new entrants. The existing workforce — the majority of practising clinicians — requires in-service programmes with dedicated time and resources. This demands that health system employers treat digital upskilling as a staffing investment rather than a personal responsibility of individual clinicians.
Public-facing digital health literacy: Patient empowerment is a stated objective of EU health policy. Achieving it requires that digital tools for health are accessible to the full population, not only to the already digitally confident. Public digital literacy campaigns, library-based support programmes, and health literacy components in adult education can each contribute — but require coordination and sustained public funding.
Monitoring and accountability: The Digital Decade 2030 framework includes eHealth access as a target metric, but access and usage data tell only part of the story. Competency and literacy measures need to be tracked systematically, disaggregated by age, geography, education level, and professional category, to allow policy adjustment based on evidence rather than proxy indicators.
The evidence base for evidence-based digital health tools continues to grow, but its clinical value is conditional: tools that patients cannot navigate and clinicians cannot integrate into workflows deliver little of that value in practice. Closing the skills gap is, in this sense, a precondition for realising the broader returns that digital health investment is expected to generate.
The Commission’s April 2024 review of the Digital Education Action Plan’s impact offers an opportunity to sharpen the health sector focus. Whether member states and the Commission use that opening to move from framework to implementation will determine whether the skills gap narrows meaningfully over the remainder of the decade, or whether investment in infrastructure continues to outpace the human capacity to use it.
