From Pilots to Practice: Why EHDS Needs a Culture of Implementation

Road to Bilbao | Reflections inspired by Iñaki Gutiérrez-Ibarluzea at the Silo Company–Bird & Bird Dialogue on AI, Digital Health and EHDS

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Europe has no shortage of digital health pilots, AI strategies or regulatory ambition. The real challenge now is implementation: how to evaluate, adopt and scale trusted solutions in real health systems. As Bilbao prepares to host the Health Data Forum Global Hybrid Summit 2026, recent discussions in Madrid on Artificial Intelligence, Digital Health and the European Health Data Space offer an important bridge from policy to practice.

As we continue on the Road to Bilbao, one message is becoming increasingly clear: Europe needs not only better digital health strategies. It needs the capacity to implement them.

This was one of the central ideas emerging from the recent Silo Company and Bird & Bird dialogue on Artificial Intelligence, Digital Health and the European Health Data Space, held in Madrid on 26 May 2026. The event brought together representatives from Spain's Ministry of Health, the Ministry for Digital Transformation and Public Administration, autonomous communities and patient voices to discuss the new framework for digital health, artificial intelligence, market access and innovation.

Among the participants was Iñaki Gutiérrez-Ibarluzea, Director of Research, Innovation and Health Evaluation at the Basque Government, who contributed to the discussion on the European Health Data Space, secondary use of health data and electronic health record systems.

For the Health Data Forum, this conversation matters deeply. It speaks directly to the challenge that Bilbao 2026 will place at the centre of the agenda: how to make the European Health Data Space real in practice.

Beyond Strategy: The Hard Work of Adoption

Across Europe, digital health and AI are no longer abstract ambitions. Strategies have been published, regulations are advancing, and pilots continue to multiply. Yet health systems still struggle with a familiar problem: moving from promising pilots to routine practice.

The Silo Company report captured this challenge clearly. Participants highlighted the need for common criteria for evaluation and adoption, the scalability of pilots and the integration of digital solutions into real healthcare settings.

This is where the implementation gap becomes visible.

A pilot may demonstrate technical feasibility. It may even show clinical promise. But adoption requires much more: shared evaluation standards, procurement pathways, governance clarity, investment, professional trust, patient confidence and alignment with health-system priorities.

Digital health is not adopted by technology alone. It is adopted by systems.

A Cultural and Transformational Shift

One of the most important conclusions of the dialogue was that the successful adoption of digital health and AI requires a cultural and transformational shift.

This means moving towards health systems that are more planned, less reactive and guided by clearer directions for all actors involved. It also means recognising that implementation requires sustained investment, not episodic enthusiasm.

This point is central to the Road to Bilbao.

The European Health Data Space will not become real simply because a regulation exists. It will become real when health systems develop the practical ability to govern, evaluate, share and use data in ways that are trusted, useful and sustainable.

That requires culture as much as infrastructure.

It requires professionals who understand the value and limits of data-driven tools. It requires citizens and patients who can see how data use serves public benefit. It requires public institutions that can align innovation with real health-system needs. And it requires technology partners who understand that healthcare transformation is not only about deployment, but about legitimacy.

The Marketplace of Algorithms: A Sign of Maturity

One of the initiatives mentioned in the Silo Company article is particularly relevant: the creation of a Marketplace for identifying AI algorithms in the Spanish National Health System and evaluating them in terms of quality, impact and cost-effectiveness.

This is an important signal.

The future of AI in health cannot depend on scattered solutions, isolated pilots or opaque claims of performance. Health systems need structured ways to know what tools exist, how they have been evaluated, where they can be used, what risks they carry and what value they generate.

A centralised inventory of AI algorithms, aligned with regulation and evaluation criteria, points towards a more mature phase of digital health adoption.

It also raises questions that are highly relevant for Bilbao:

How should health systems evaluate AI tools before adoption?

What evidence is needed to demonstrate impact?

How should cost-effectiveness be measured?

How can algorithms be monitored after deployment?

How can we ensure that AI tools are not only technically impressive, but clinically useful, ethically robust and socially trusted?

These questions are not peripheral. They are at the heart of responsible implementation.

EHDS and the Value of Secondary Use

The second panel of the Madrid event focused on the European Health Data Space, with particular attention to secondary use of data and electronic health record systems.

This is the exact territory that Bilbao 2026 will explore in depth.

The Bilbao Summit is designed around a practical question: how do we make EHDS work in real-world settings, particularly for high-dimensional data such as genomics and imaging, while ensuring trust, security, interoperability and meaningful secondary use?

The Silo Company dialogue reinforces why this question matters. EHDS is not only a European policy framework. It is a test of whether Europe can create the conditions for health data to support better research, better innovation, better care and better system performance.

Secondary use of health data will be essential for the future of healthcare and life sciences. But it will only be sustainable if health systems address the foundations first: data quality, interoperability, governance, cybersecurity, public trust and clear evidence of societal value.

This is why the Health Data Forum has consistently argued that the future of AI in healthcare depends on getting the data foundations right.

From Data Access to Health-System Value

The Road to Bilbao is about more than access to data. It is about the value that can be created when data is used responsibly.

Digital health, AI and EHDS should not be treated as separate agendas. They are part of the same transformation.

Digital health creates new ways of delivering and organising care.

AI creates new possibilities for insight, prediction, automation and decision support.

EHDS creates a new framework for trusted data use across institutions, regions and borders.

But the real question is whether these three forces can be aligned around health-system value.

Can they improve outcomes?

Can they reduce fragmentation?

Can they support prevention?

Can they help clinicians and patients make better decisions?

Can they accelerate responsible innovation?

Can they strengthen public trust rather than weaken it?

These are the questions that must guide implementation.

Why Bilbao Is the Right Place for This Conversation

Bilbao offers a strong setting for the next stage of this dialogue.

The Basque context brings together health-system experience, innovation capacity and a practical interest in making data work in real settings. The Bilbao Summit will focus on genomics, imaging, trusted secondary use, cybersecurity, interoperability and infrastructure — not as abstract themes, but as implementation challenges.

This matters because high-dimensional data such as genomics and imaging will test the maturity of EHDS in very concrete ways.

These data types are complex, sensitive, large, valuable and difficult to govern. They raise questions of storage, access, consent, re-identification risk, clinical integration, research collaboration and public trust.

If Europe can learn how to manage these data responsibly and effectively, EHDS can become more than a regulatory milestone. It can become a practical engine for better health and better science.

From Madrid to Bilbao

The Madrid dialogue organised by Silo Company and Bird & Bird reminds us that Spain is already actively discussing the future of AI, digital health and EHDS implementation.

For the Health Data Forum, this is not a separate conversation. It is part of the same journey.

The Road to Bilbao is precisely about connecting these conversations across events, institutions and regions, and turning them into a shared implementation agenda.

From patient-centred value to algorithm evaluation, from digital health adoption to secondary use, from national strategies to European data spaces, the message is clear:

The next phase of health data transformation will not be won by pilots alone.

It will require governance, culture, evaluation, trust and sustained implementation capacity.

That is why Bilbao matters.

It is where we move from ambition to readiness.

From pilots to practice.

From data access to health-system value.

Source note
This article is part of the Road to Bilbao editorial series and is inspired by Iñaki Gutiérrez-Ibarluzea's participation in the Silo Company–Bird & Bird dialogue "Artificial Intelligence, Digital Health and the European Health Data Space: A New Framework for Market Access and Innovation," held in Madrid on 26 May 2026.