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Author: Wendy Kwaku Yeboah is a PhD candidate in EU law at the University of Bologna, with a particular focus on EU health law and its digitalisation. Her research explores the regulation of cross-border telemedicine within the framework of the EU internal market, examining both the constitutional and operational dimensions of EU health governance. She investigates how EU law shapes access to healthcare across borders, the challenges of ensuring patient safety and data protection in digital health services, and the evolving role of the Court of Justice of the European Union in this field.

This piece builds on my doctoral research and reflects the presentation I gave at a EUHealthGov panel during the UACES 2025 conference. I am grateful to the EUHealthGov network for providing financial support for my participation, and to all panel participants for their valuable contributions to the discussion. Any errors are solely my responsibility.

Telemedicine moved from niche to necessary during COVID-19. The EU has since built important pieces of a digital health architecture – but cross-border care still runs into legal grey zones and uneven infrastructure. Here’s what works, what doesn’t, and what to fix next.

Why telemedicine matters now

The pandemic turbo-charged digital care and exposed long-standing weaknesses in health systems. Backed by unprecedented EU recovery funding, telemedicine has become a mainstream complement to in-person services – linking patients and clinicians across distance and time. But when care crosses borders, telemedicine stops being just a technical solution and becomes a legal, ethical, and governance stress test for the internal market.

What counts as telemedicine (and why definition matters)

Telemedicine is not one thing. It spans teleconsultation, telediagnosis, remote monitoring, and tele-expertise, often threaded with AI-enabled tools. This multifunctionality puts it at the crossroads of health policy, the internal market, and fundamental rights. Member States retain control over how they organise and finance care; the EU leans on internal-market powers to harmonise the digital rails (data protection, digital identity, AI). The result? An innovation that is inherently cross-border is governed by rules that are still mostly national.

The EU’s legal framework for telemedicine rests on solid principles but remains weak in practice. The Court of Justice has long confirmed that healthcare falls under the free movement of services, and Directive 2011/24/EU established the foundations for patient mobility, supported by mechanisms such as National Contact Points and the eHealth Network. Yet the directive was not designed with digital care in mind and leaves unresolved key issues like quality standards, liability, interoperability, cybersecurity, and AI-assisted decision-making. As a result, much is left to national discretion, creating a fragmented landscape that complicates life for both providers and patients.

EHDS: building the backbone, not the whole body

The European Health Data Space (EHDS) Regulation is a potential game-changer for telemedicine’s plumbing. By standardising formats and enabling secure access to electronic health records (and, progressively, imaging, labs, and discharge reports), it tackles one of the biggest blockers: data that won’t travel.

But the EHDS is infrastructure, not a telemedicine code. It doesn’t settle who is responsible when care goes wrong, how AI recommendations fit with clinical judgment, or how remote-only practice should be accredited. One telling sign: a clause that would have actively promoted cross-border telemedicine fell out during negotiations.

Data and ethics: where the rubber meets the road

Telemedicine runs on sensitive data. GDPR provides a common floor, but national overlays (medical secrecy, access rules, secondary-use controls) differ widely. In practice, providers face divergent consent models, storage requirements, and audit expectations.

Layer in the AI Act and the stakes rise. High-risk health AI must meet transparency, traceability, and human-oversight requirements. That is good for trust, but unresolved in cross-border settings are basic questions: Which authority supervises? How is accountability shared between clinician, institution, and vendor when an algorithm errs? How do we preserve clinical judgment without neutering useful automation?

Ethically, telemedicine can strain informed consent and continuity of care, and—without inclusive design—amplify digital divides for older adults, rural communities, and people with disabilities.

Cross-border telemedicine still faces stubborn obstacles. Liability and jurisdiction remain unclear when adverse outcomes arise, often relying on ad hoc contracts that cannot scale. Professional qualifications are mutually recognised in theory, yet remote-only practice is frequently caught in national grey zones or subject to extra conditions. Reimbursement rules, designed for physical travel, rarely fit virtual care, leaving both patients and providers in doubt. On top of this, uneven digital infrastructure—ranging from electronic health record maturity to coding standards and connectivity—makes even routine cross-border consultations technically complex and unequal.

A realistic way forward (that could start tomorrow)

No grand telemedicine regulation is likely adopted overnight. But the EU and Member States can take pragmatic steps that add up. My research suggests we need a three-pronged approach.

First, targeted telemedicine-specific reforms. We can’t keep expecting a directive that merely mentions telemedicine to govern its complex cross-border realities. We need clear liability frameworks for cross-border care, harmonized professional recognition for digital practice, and coherent reimbursement standards specifically designed for virtual care.

Second, rights-based innovation. The solution isn’t choosing between innovation and patient protection – it’s designing systems that deliver both. We need telemedicine frameworks that enhance rather than replace clinical judgment, data governance that enables sharing while protecting privacy, and digital tools that reduce rather than increase health inequalities.

Third, coordinated but targeted implementation. Yes, the European Health Data Space will help with infrastructure, but we cannot mistake better data sharing for comprehensive telemedicine governance. We need telemedicine-specific interpretations of the GDPR and AI Act to avoid regulatory confusion.

Here’s my central argument: The EU stands at a crossroads. We can either continue with our current fragmented approach and watch telemedicine’s transformative potential slip away, or we can seize this moment to build a truly integrated Digital Health Union.

The bottom line

In conclusion, the pandemic taught us that health crises don’t respect borders. Our coordinated European response showed us that cooperation saves lives. Now, as we build back better, we must ensure our legal frameworks are as innovative as the technologies they govern.

Telemedicine is now a central pillar of European healthcare – not a pilot project. The EU has assembled critical pieces (GDPR, AI Act, EHDS), but they amount to an incomplete kit for cross-border care. To unlock the internal market’s advantages without compromising patient rights, the EU needs a tighter weave between infrastructure and rules: clear liability and jurisdictional defaults, workable accreditation for remote practice, interoperable data that clinicians can actually use, and reimbursement that follows patients – not borders.

Get those elements right, and telemedicine can deliver what it promised in the pandemic’s crucible: resilient, inclusive, and truly European care.

 

 

The post Cross-Border Telemedicine in the EU: Promise, Pitfalls, and the Path Ahead appeared first on Ideas on Europe.

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AMENDMENTS 1 - 212 - Draft report Relations between the EU and Saudi Arabia
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Hana Jalloul Muro

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