In my previous column, I wrote about the first pillar of the Digital Health Strategy 2026–2030: interoperability, or the need for the healthcare system to speak a common language. The focus was on order within the system, standards, data, and the new digital grammar of healthcare. But the language of the system only has meaning if, in the end, it allows it to listen better to the individual. That is why the second pillar of the strategy is focused on how digitalization can become visible, useful, and dignified for the patient.
By Azir Aliu
The purpose of healthcare does not reside in the institutions on which it is built; it stems from the individual who needs treatment. Every strategy, system, law, and technology must ultimately be judged through the lens of whether the patient can access services more easily, whether they feel more secure, whether they better understand their health condition, and whether they feel that the system sees them as a person rather than as an object in an administrative procedure.
The second pillar of the strategy opens the discussion on patient-centered care, modern digital services, and continuous healthcare support throughout the treatment journey. If the first pillar organizes the system’s internal architecture, the second pillar opens the door to the patient. It marks the transition from digitalization that serves only institutions to digitalization that also serves citizens. The institutional network that gathers information evolves into a public health service that transforms those data into rights, security, practical support, and trust.
Our healthcare system has already laid important foundations. “My Appointment” transformed the way appointments and referrals are scheduled. Electronic prescriptions simplified access to therapy. The telemedicine module demonstrated that part of healthcare services can be brought closer to patients, particularly when geography, time constraints, or a shortage of specialists create real barriers. We have implemented digital solutions that have already changed the everyday interaction between citizens and the healthcare system.
But the next step is larger than scheduling appointments or accessing prescriptions. The next step is to give citizens a genuine place in their own healthcare story—to transform them from passive recipients of decisions into informed participants in their treatment. This means giving citizens access to their health records, enabling them to follow their medical history, know what data exist about them, who has accessed it, for what purpose, and on what legal basis. It also means allowing them, when necessary, to authorize another person so they can participate more effectively and knowledgeably in their treatment process.
A health record is the personal medical memory of every individual, extending far beyond administrative documentation. It contains and preserves the most sensitive information about a person: illness, therapy, risk, fear, hope, and outcome. When patients have no access to this information, they easily become dependent on the system. But when they do have access, they gain the opportunity to become partners in safeguarding their own health.
In modern healthcare, patients can no longer be passive recipients of decisions. This is especially true for chronic diseases, long-term therapies, prevention, and screening, where success depends on active cooperation between the patient and the healthcare team. A patient with diabetes, hypertension, cardiovascular risk, or another chronic condition requires continuity. Their care does not begin and end with a single appointment. It continues every day through monitoring, therapy, checkups, habits, alerts, and timely communication.
Digital services can create a new quality of care, one that becomes visible when patients can view their results, track their therapy, receive information about upcoming checkups, access recommendations, and communicate with the system through secure channels. Only in such an institutional environment can healthcare become less fragmented and more continuous. This is the essence of the second pillar: ensuring that patients do not get lost among institutions, documents, and procedures, but instead have a clear pathway through the system.
The strategy foresees the development of a patient portal integrated into the existing digital infrastructure. It will be a personal, secure, and understandable space for citizens. Through it, patients should have access to their health records, insight into who has accessed their data, the ability to manage consent, and the option to authorize a representative. For older people, children, patients with complex conditions, or individuals dependent on family care, this will provide practical day-to-day support.
This direction of healthcare digitalization is neither unfamiliar nor experimental. The European Health Data Space is built precisely on the principle that citizens should have access to and greater control over their own electronic health data. MyHealth@EU is already developing cross-border electronic services such as e-prescriptions and patient summaries, ensuring that health information can follow patients beyond their national borders. Estonia has shown that citizens can access their health data and see who has viewed it. Denmark, through its national portal sundhed.dk, demonstrates how a patient portal can become a central public service through which citizens access medical records, laboratory results, medications, and other health information. These examples show that when a system is well designed, patient access does not necessarily create risk—it becomes a source of trust.
But trust does not emerge on its own; it must be built through rules. Patient access to data must be accompanied by strong protection measures, verification, access control, records of who used the data, consent management, and robust procedures for handling incidents. In healthcare, data security is part of patient safety. Information must be available when needed for care, yet protected against any unauthorized use.
The second pillar also carries an important social dimension. Digitalization must not become a new line of division between those who can use digital services and those who are left behind. Older people, citizens in rural areas, persons with disabilities, low-income families, and communities with lower levels of digital literacy must be included from the very design stage of services. Inclusion, as a guiding value, is the condition for digital healthcare to be fair.
This is why digital literacy becomes an integral part of healthcare policy. If citizens do not know how to access a service, if the interface is difficult to understand, if the language is overly complex, or if the system requires more steps than users can realistically navigate, then the service formally exists but is not truly accessible in people’s everyday lives. Technological progress in healthcare requires equal attention to human readability.
Telemedicine is one of the most important instruments in this direction. It is not intended to replace physicians or physical examinations. Rather, it can reduce the importance of distance and narrow the gap between patients and specialist care. We have already demonstrated its effectiveness through the successful telemedicine pilot project in Debar and Delchevo, where patients were connected to the University Clinic for Dermatology and Venereology in Skopje and received specialist consultations without traveling to the capital. For many consultations, follow-up visits, chronic patient monitoring, and support for local healthcare institutions, telemedicine saves time, money, and effort—particularly for citizens living far from major medical centers. In this context, telemedicine should also be understood and embraced as a tool for regional equity in healthcare.
In the future, telemedicine-based patient monitoring will play an even greater role, helping the healthcare system move beyond reacting only when a person’s condition deteriorates. For some chronic patients, regular monitoring of health parameters, timely alerts, established protocols, and communication with healthcare teams can prevent complications and unnecessary hospitalizations.
Within this framework, the next step will be the careful introduction of artificial intelligence-supported digital services integrated into the national electronic health record. Algorithms will not make decisions or replace physicians. Their role will be to help identify risks in a timely manner, organize priorities, support clinical assessments, and provide patients with clearer guidance through the healthcare system. For chronic patients, AI tools can help detect changes in health parameters, remind them of checkups, support monitoring protocols, and improve coordination between patients, family doctors, and specialists. Yet the fundamental principle remains unchanged: technology provides support, while responsibility, judgment, and final decisions remain in the hands of medical professionals. Only in this way can artificial intelligence contribute to a more humane, safer, and more precise healthcare system.
Continuity of care is becoming one of the key concepts in the digital transformation of healthcare. Patients should never feel that each institution starts from scratch or that every doctor asks them to tell the same story again. When the system has organized data, patient access, digital services, and interconnected levels of care, treatment continues seamlessly—from family doctor to specialist, from hospital to home care, from diagnosis to follow-up, and from therapy to prevention.
The second pillar is not merely an effort to expand digital services; it seeks to establish a qualitatively new relationship between patients and the healthcare system. A relationship in which informed patients enjoy greater insight, greater control, greater security, and greater opportunities to participate.
If the first pillar was the language of the system, the second pillar is the voice of the patient—a voice that must be heard even while the system itself is being designed.
By 2030, our goal is for patients to have a safer and more dignified path through the healthcare system, guaranteed access to their data, the knowledge needed to use it, and reliable support even when they live far from a regional hospital. Ultimately, the systemic ambition we have set is for patients to become partners in their own treatment.
The author is Minister of Health of North Macedonia