Four years of testing reveals top priorities for managing digital health pilots across Europe

Running large digital health projects across multiple countries is hard. Coordinating teams and technology in different places often leads to confusion. A group of 23 experts from four European pilots worked together to solve this problem. They spent four years testing a practice-derived management framework to see what actually works. Their goal was to create a clear path for executing these complex projects without losing track of the people involved. The team ranked 45 best practices across six operational domains to find the most useful steps. Usability testing and user-centered digital tool design emerged as top priorities. Active recruitment strategies also stood out as essential for getting the right people involved from the start. This guidance offers actionable steps for coordinating large, distributed, multi-site digital health deployments. The advice is consensus-validated, meaning the experts agreed on these points after careful review. While actionable guidance for executing federated, multinational eHealth pilots remains limited in the implementation literature, this work fills a gap. It provides a solid foundation for future projects aiming to scale digital health solutions across borders.