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 the3C-3P Community (Co-Creation Community of Patients, Professionals, andProgrammers), as developed within the XpanDH project. The deliverable exploreshow this collaborative framework was designed and operationalised to support theadoption of the European Electronic Health Record Exchange Format (EEHRxF) andadvance the European Health Data Space (EHDS). The document begins by introducing the background, scope, and objectives of theX-Bundle initiative, which aims to engage diverse stakeholders—IT developers,healthcare professionals, and patients—in a transparent and sustainable co-creationenvironment. The community's structure is defined in terms of its core objectives,governance, and operational methodologies, which draw on successful models suchas openNCP and openHIE. The rationale and methodological approach outline the guiding principles andstrategies for community formation, focusing on inclusivity, collaboration, and thereuse of assets developed in previous work packages. Particular emphasis is placedon the establishment of a Plenary Community of Doers and several specialisedworking 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 productinformation (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 highlyattended on-site meeting of the 3C-3P-MDT group during the 1st Greek Forum onCancer: Policy, Research & Funding Strategies on July 2nd, 2024, and a notable seriesof 3 intense plenary sessions from the 3C-3P-EPD group held in the last trimester of2024. Such workshops served as platforms for knowledge-sharing, co-creation, andrefining tools to support EEHRxF adoption. Key lessons learned and recommendations highlight the challenges and enablersencountered during the process, providing actionable insights for sustaining andscaling the community. Finally, the deliverable outlines the continuation and nextsteps, ensuring the momentum of the X-Bundle initiative is maintained and itscontributions to the EHDS are expanded. This deliverable not only captures the foundational efforts behind the 3C-3PCommunity but also serves as a roadmap for fostering collaborative innovation andsustainable governance in digital health interoperability initiatives. Following the plenary Community of Doers workshop during the European DigitalHealth Interoperability Days held at Iscte in Lisbon, Portugal in December 2024, a setof other possible WGs have been identified, and while the synergies between thisbottom-up participated and co-created manner and the top-down “formatImplementing Acts” approach will be difficult at times, it seems essential to ROOTthe format in concrete value-adding processes of care