D5.3 – X-bundle open-source community of the doers

This deliverable provides a comprehensive overview of the philosophy, structure,
and key outcomes of the X-Bundle open-source community initiative, known as the
3C-3P Community (Co-Creation Community of Patients, Professionals, and
Programmers), as developed within the XpanDH project. The deliverable explores
how this collaborative framework was designed and operationalised to support the
adoption of the European Electronic Health Record Exchange Format (EEHRxF) and
advance the European Health Data Space (EHDS).

The document begins by introducing the background, scope, and objectives of the
X-Bundle initiative, which aims to engage diverse stakeholders—IT developers,
healthcare professionals, and patients—in a transparent and sustainable co-creation
environment. The community's structure is defined in terms of its core objectives,
governance, and operational methodologies, which draw on successful models such
as openNCP and openHIE.

The rationale and methodological approach outline the guiding principles and
strategies for community formation, focusing on inclusivity, collaboration, and the
reuse of assets developed in previous work packages. Particular emphasis is placed
on the establishment of a Plenary Community of Doers and several specialised
working groups.

Four working groups were established during the course of the project:
1. Multidisciplinary tumour boards for cancer patients (3C-3P-MDT)
2. Electronic prescription, electronic dispensation and electronic product
information (3C-3P-EPD)
3. Multi-Country working group on imaging – CoD (3C-3P-MIM)
4. Telehealth— Teleconsultation Encounter Report (3C-3P-TER)

These groups facilitated targeted discussions and workshops, including a highly
attended on-site meeting of the 3C-3P-MDT group during the 1st Greek Forum on
Cancer: Policy, Research & Funding Strategies on July 2nd, 2024, and a notable series
of 3 intense plenary sessions from the 3C-3P-EPD group held in the last trimester of
2024. Such workshops served as platforms for knowledge-sharing, co-creation, and
refining tools to support EEHRxF adoption.

Key lessons learned and recommendations highlight the challenges and enablers
encountered during the process, providing actionable insights for sustaining and
scaling the community. Finally, the deliverable outlines the continuation and next
steps, ensuring the momentum of the X-Bundle initiative is maintained and its
contributions to the EHDS are expanded.

This deliverable not only captures the foundational efforts behind the 3C-3P
Community but also serves as a roadmap for fostering collaborative innovation and
sustainable governance in digital health interoperability initiatives.

Following the plenary Community of Doers workshop during the European Digital
Health Interoperability Days held at Iscte in Lisbon, Portugal in December 2024, a set
of other possible WGs have been identified, and while the synergies between this
bottom-up participated and co-created manner and the top-down “format
Implementing Acts” approach will be difficult at times, it seems essential to ROOT
the format in concrete value-adding processes of care