Remote Patient Monitoring Across European Health Systems: Policy Insights from a Cross-Country Stakeholder Study.

Background/Objectives: Remote patient monitoring (RPM) is recognized as a key component of health system transformation in Europe, in the context of vulnerable populations. However, its large-scale adoption remains uneven across countries. The research explored how technical infrastructure, governance and regulation, interoperability, and ecosystem readiness influence RPM adoption and scale-up in seven European country contexts. Methods: An exploratory qualitative cross-country study combined targeted desk research with semi-structured interviews conducted between February and March 2025. The interviews were recorded with consent, manually transcribed, anonymized, and analyzed using a manual hybrid deductive-inductive thematic approach. The desk research provided contextual information and remained distinct from the interview-derived findings. Results: The analysis was organized around four higher-order themes including digital infrastructure and RPM technologies; governance and regulatory frameworks; interoperability and health-data integration; implementation barriers and ecosystem readiness. RPM technologies were present in all examined contexts, but their integration into routine care remained uneven. Recurrent barriers included fragmented reimbursement pathways, uneven operationalization of EU rules, limited interoperability, weak integration with Electronic Health Records and clinical workflows, digital-literacy gaps, and insufficient mechanisms for progressing from pilots to sustained implementation. Conclusions: Stakeholders more frequently identified system-level implementation conditions, including governance, reimbursement, interoperability, and workforce readiness, than technology availability alone as barriers to RPM scale-up. The European Health Data Space may provide an enabling framework, but its impact will depend on national and regional implementation capacity.