## 4 Discussion
### Evolution of Digital Health in Poland
These regulatory milestones coincided with the development of the core infrastructure, including the P1 platform and IKP, which enabled the delivery of scalable digital services. The COVID-19 pandemic has further accelerated digital adoption, resulting in a significant increase in publication volumes, particularly between 2020 and 2022 [35]. Over the past decade, Poland has transitioned from fragmented and experimental telemedicine efforts to establishing coordinated, legally sanctioned, and partially interoperable eHealth ecosystems. Key drivers include top-down legal reforms, EU-supported infrastructure development, increased professional acceptance, and disruptive but catalytic influence of the COVID-19 pandemic. Legislative decisions mandating e-prescriptions, e-referrals, and the rollout of the IKP were the most visible accelerators of systemic change. These milestones have enabled large-scale adoption by integrating digital tools into clinical workflows, reimbursement frameworks, and patient engagement strategies. While centralizing key services, the national digitization strategy laid the groundwork for expanded data sharing, user authentication, and remote service delivery, which became critical during the pandemic. Notably, COVID-19 has accelerated the digitization of healthcare delivery and significantly reshaped the specialty landscape. Fields with minimal or no prior engagement in telemedicine, such as geriatrics, pulmonology, infectious diseases, and palliative care, saw rapid adoption of digital tools. In some cases, such as palliative medicine and respiratory care, COVID-related studies constituted the only publications on digital health, suggesting that the pandemic served as a trigger for digital innovation in those domains. Simultaneously, mature specialties such as cardiology and rehabilitation have transitioned from feasibility studies to rigorous clinical trials and outcome-based evaluations. Notably, over 50% of cardiology-related articles involve patient-level data, with several evaluating the use of remote monitoring and telerehabilitation in chronic disease management. The digital footprints of mental health, psychiatry, and neurology have expanded their digital footprints through mHealth applications, AI-supported diagnostics, and video consultations, reflecting both clinical necessity and increased societal demand. Conversely, traditional strongholds in digital health research from the pre-2015 period, such as pathology, orthopedics, and technical imaging, showed a relative regression in research activity. Despite advances in teleraliology infrastructure, the number of specialty-specific publications has decreased, possibly due to integration into broader health IT systems or shifting research funding priorities. Artificial intelligence (AI) is an area of significant development. Although still emerging, AI applications in Poland's healthcare system, particularly in cardiology, oncology, and geriatric, include natural language processing (NLP) for electronic health records (EHRs), image recognition in radiology, and AI-assisted cognitive assessments [216]. However, its integration into the clinical workflow remains limited. Regulatory ambiguity, lack of reimbursement models, and insufficient clinician training/impeding their widespread implementation. This regulatory lag is particularly evident compared to countries such as Germany, which has legislated digital therapeutics (DiGAs) [217], or Estonia [218], which operates under a fully digitalized, blockchain-secured health infrastructure [219; 220]. Poland's strength lies in its centralized platforms and capacity for rapid policy execution. However, its weakness is the slow translation of innovation into everyday clinical practice and limited long-term evaluation of digital interventions. Furthermore, the distribution of study types underscores the advanced maturity of digital health research.