## 7 Conclusions and Future Work  
Data sovereignty, security, and interoperability remain pivotal for a European digital infrastructure, particularly in regulated domains such as healthcare. The Gaia-X-Med project aimed to test the applicability of Gaia-X concepts to address these challenges, focusing on trust and consent. The project leveraged the open-source Yo-Ga-X framework to implement Gaia-X principles across six diverse eHealth use cases, each representing unique requirements for secure and compliant data sharing. The results demonstrated that the Gaia-X concepts are effective in business-to-business contexts, where trust can be established through organizational credentials. However, when involving individual patients, the existing Gaia-X framework encountered limitations. Patients, often unaligned with any organization, face technological burdens in participating directly in federations, indicating a need for further conceptual evolution of Gaia-X to support independent data contributors. To address the identified limitations, future work should focus on extending Gaia-X to better accommodate individual data contributors such as patients. The integration of personal data wallets or similar technologies would empower individuals to manage their data directly, ensuring compliance with privacy regulations, while maintaining full sovereignty. This shift would require additional Gaia-X conceptual modifications, such as treating individuals as standalone participants in federations, with tailored onboarding and credentialing processes that reduce technological barriers. Furthermore, regulatory enhancements could significantly improve Gaia-X's scalability and utility. Establishing standardized trust anchors and clearinghouses would enhance the verification of credentials and governance of federations, fostering trust among participants. Similarly, incorporating policies to enforce federation-wide constraints on data exchange, including post-consumption lifecycle management, would bolster data security and compliance. Interoperability across Gaia-X implementations, such as XFSC, EDC, and Yo-Ga-X, should also be prioritized. Unified frameworks and shared standards would enable seamless collaboration across domains, realizing Gaia-X's vision of interoperable, federated ecosystems. Finally, traceability mechanisms, such as immutable contract and service consumption records maintained by neutral entities, could address inconsistencies and support conflict resolution. Broadly, future efforts should consider the global landscape, learning from less regulated but more user-friendly approaches in other regions. Combining stringent European data protection standards with practical usability enhancements would make Gaia-X a robust model for secure and sovereign data ecosystems, particularly in sensitive domains like healthcare. Conceptualization, all authors; methodology, all authors; software, B.G. and H.H. ; validation, B.G. and H.H. ; investigation, B.G. and H.H. ; writing--original draft preparation, B.G. and H.H. ; writing--review and editing, S.F. and M.L. ; visualization, B.G. and H.H. ; supervision, S.F. and M.L. ; project administration, S.F. and M.L. ; funding acquisition, S.F. and M.L. The authors used generative AI to make some of the descriptions more concise and streamlined. All authors have read and agreed to the published version of the manuscript. This research was funded by the German State of Schleswig-Holstein, within the funding framework \"Kunstliche Intelligenz\". The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. **Acknowledgments:** The authors wish to thank [PERSON] from the government of Schleswig-Holstein for continuous support of their activities in investigating AI applications in the healthcare domain, their colleagues in the other work packages of Gaia-X-Med for commenting on the solutions developed, and [PERSON] for being a continuous source of inspiration.