Powered by Fondazione Toscana Gabriele Monasterio (FTGM)

To drive digital transformation forward, EHTEL member, Monasterio is actively participating in major European initiatives – including xShare, i2X, and XiA – while proudly chairing the flagship Hospitals on FHIR European community. Monasterio outlines how, with these four initiatives, it is helping to build the foundations of a connected European healthcare ecosystem.

What is Monasterio doing to bridge clinical care and European digital transformation?

Delivering cutting-edge care today demands seamless, secure, and standardised data flows.

The core mission of Fondazione Toscana Gabriele Monasterio (FTGM), a foundation for specialised public research hospitals based in Pisa and Massa (Tuscany, Italy), is to concentrate on clinical excellence in cardiovascular care and rare diseases. Monasterio’s internal BioEngineering department, has 25+ years of experience in IT research and applications in the development of eHealth solutions. It is the provider of electronic health records for the whole Tuscany Region.

As an active member of EHTEL, Monasterio is deeply committed to translating the vision of the European Health Data Space (EHDS) into daily clinical reality. Hospital information systems cannot continue to remain as isolated silos. To deliver continuity of care across borders and power secondary research and artificial intelligence, health data must speak a single, standardised language.

These synergies help shape the future of European interoperability between hospitals and other levels of healthcare.

Unlocking data fluidity for patients and research - the xShare project

The xShare project addresses a core mandate of digital health: it empowers citizens with data access while enabling fluent data-sharing between clinical care and research. At the centre of xShare is the xShare button – a user-friendly digital mechanism which enables individuals to access and share their health data across diverse digital health platforms.

In xShare, Monasterio plays a crucial role as a pilot site which is developing and testing adoption scenarios in hospital networks in Italy.

Two key activities supported by Monasterio in xShare include:

• Primary Data Use: Mapping hospital data flows to core primary use domains of the European Electronic Health Record Exchange Format (EEHRxF) is a key activity of xShare. Monasterio is currently the only hospital in Europe certified in the implementation of e-prescriptions, lab reports, medical imaging, and discharge summaries.
• Operationalising Public Health and Research: Monasterio works on the International Patient Summary for Research (IPS+R) specification. It helps establish standardised pathways that turn routine clinical data into research datasets. In xShare, Monasterio focuses on antimicrobial resistance, healthcare-associated infections, and cardiology.

By embedding xShare standards into Monasterio’s hospital infrastructure, bedside clinical data immediately fuels research without adding any redundant administrative tasks to the work of healthcare staff.

Implementing the EEHRxF intelligently in live clinical settings: the i2X project

Standard specifications set the rules, but real-world adoption happens at a patient’s bedside. The i2X project moves standards off the drawing board and into live hospital environments. i2X brings together demonstration sites across 12 European Union (EU) Member States to showcase in-service, cross-border, and national exchange of health data aligned with EEHRxF guidelines.

As i2X’s pilots work package leader and healthcare delivery partner, Monasterio tests and validates these solutions in specialised clinical departments.

In i2X, Monasterio’s focus is on three vital pillars:

• Zero-Burden Interoperability: Ensuring automated data mapping and FHIR-based exchange reduces clinician workloads. Monasterio tests automated data extraction tools integrated directly into hospital workflows.
• Multi-Domain Testing: Validating pilot scenarios covers several essential priority domains. It specifically targets high-complexity data categories such as laboratory reports, medical imaging, and discharge reports.
• AI-Enabled interoperability: Exploring how AI tools sit atop standardised data streams. By ‘reverting’ (restoring) data in/to EEHRxF/FHIR formats, Monasterio develops AI models that ingest unstructured data seamlessly from both internal and external sources.

Through its work in i2X, Monasterio demonstrates that standardised health data exchange is operationally sustainable in high-throughput hospital environments.

Closing the Interoperability Skills Gap Across Europe: the XiA project

Technology and standards are only as effective as the workforce behind them. Monasterio recognises that transitioning towards the EHDS requires a workforce proficient in modern interoperability standards. For this reason, it is participating in the XiA project, an Erasmus+ initiative dedicated to closing the digital health skills gap across Europe.

XiA brings together healthcare providers, academic institutions, and industry leaders to design and deliver accredited educational pathways focused on HL7 FHIR, EEHRxF implementation, digital health governance, and cybersecurity.

Monasterio’s contributions to XiA focus on hospital discharge reports.

The project’s three key areas of work are:

• Tailored Learning Pathways: It develops practical curriculum modules for hospital IT teams, Chief Medical Information Officers (CMIOs), software vendors, and clinicians.
• Micro-Credentials and Certification: It supports scalable training frameworks that recognise specialised interoperability skills across European borders.
• Hospital Capacity Building: It equips technical and clinical teams with hands-on skills required to configure FHIR APIs, manage data mapping, and enforce health data governance.

By building human capacity alongside digital infrastructure, XiA ensures European hospitals possess the expertise required to sustain EHDS implementation over the long term.

Leading the Community: Hospitals on FHIR & the Pisa User Days

Central to Monasterio’s leadership in European digital health is its role in Hospitals on FHIR.

Hospitals on FHIR provides a pragmatic, peer-driven platform for healthcare delivery organisations to share real-world experiences, software architectures, and lessons learned in adopting HL7 FHIR as a core data exchange layer.

Monasterio’s Chief Digital Officer, Stefano Dalmiani, serves as the Chair of Hospitals on FHIR, a European initiative launched under HL7 Europe to unite hospital leadership, IT architects, clinicians, and technology partners.

This year, Monasterio is hosting the Hospitals on FHIR Pisa User Days in Pisa, Italy: see here.

Co-Creating the European Health Data Ecosystem

Digital health transformation cannot occur in isolation. Here is a practical experience of how these four initiatives are working together. By connecting the strategic standards of xShare, the real-world clinical testing of i2X, the workforce empowerment of XiA, and the peer-led community building of Hospitals on FHIR, Monasterio is helping to build the foundation of a connected European healthcare ecosystem.