Deploying the Medical Informatics Platform for cross-border federated analytics in FERES and eCREAM

Emergency medicine generates vast quantities of electronic health record (EHR) data across hospitals and countries, but leveraging these datasets for research and quality improvement is challenging due to privacy regulations, data silos, and heterogeneity of systems. Here, we describe how the Medical Informatics Platform (MIP) operationalizes cross-border federated analytics, combining governance, privacy-preserving data preparation, secure deployment, and federated execution as illustrated through the FERES and eCREAM federations. Each participating site runs a local MIP “node” containing its anonymized dataset behind its firewall; analysis queries are executed locally, and only aggregated results are shared to a central interface. Through this approach, sensitive patient data never leave their site of origin, yet clinicians and researchers can collaboratively analyze large multi-centric datasets in real time via a web-based interface. The MIP provides an intuitive, visualization-rich environment where users can select variables, apply statistical or machine learning algorithms, and interactively review results through charts and graphs. Robust governance and security measures are built-in: data remain under the control of the original institutions (who act as data controllers), all datasets are harmonized to common data models and irreversibly anonymized prior to analysis, and the platform enforces strict privacy safeguards to protect against re-identification. The MIP has been deployed in EU funded initiatives including the Federating European REgistries for Stroke (FERES) project, which is part of the larger EBRAINS initiative, and the eCREAM (enabling Clinical Research in Emergency and Acute care Medicine) retrospective observational multicenter study, allowing cross-border analyses of stroke outcomes and emergency department data while complying with GDPR and national regulations. By enabling international EHR collaborations without compromising patient privacy, the MIP shows how electronic records can support cross-border research and quality-improvement analyses in emergency medicine. This manuscript primarily reports the implementation approach and operational blueprint; it is not presented as a clinical outcomes study or a usability evaluation.