## 4 Discussion
### Evolution of Digital Health in Poland
Compared to the pre-2014 scenario, characterized by localized pilot projects and minimal institutional coordination, the Polish digital health system has undergone substantial transformation, allowing for an assessment of regional maturity. The establishment of national platforms (e.g., e-prescriptions, e-referrals, IKP), innovative projects executed under public-private partnerships, and a formalized legal framework have enabled Poland to attain a medium level of eHealth maturity in Europe. Estonia remains a regional leader because of its fully integrated electronic medical records and blockchain-secured systems [220,223]. Germany has pioneered regulations for artificial intelligence and digital therapies [224,225], and Poland has surpassed countries such as Hungary, Romania, and Bulgaria in terms of telemedicine infrastructure and utilization. Poland's eHealth integration and governance ecosystem encompasses interdisciplinary and interconnected domains, public administration, healthcare providers, patients, technology developers, and research institutions linked by digital platforms and policy bridges. These bridges include a national eHealth strategy, GDPR-based regulatory updates, and a P1 health information infrastructure. Key areas of convergence include reimbursement reforms, digital skill initiatives, and cross-sector research collaborations. A visual model of the ecosystem reflects the interdependencies and direction of influence between these actors. The path towards sustainable innovation requires the institutionalization of telemedicine in reimbursement systems, prioritizing digital integration, and introducing mandatory interoperability between platforms. Developing training programs for healthcare professionals, particularly those aimed at bridging the digital skill gap among older doctors, is essential. Training in this area must be included in the curriculum of medical universities in the clinical sciences section, as students are familiar with clinical examination methods and have a basic understanding of disease diagnosis and treatment. Ethical oversight mechanisms should be strengthened to address concerns about AI implementation of artificial intelligence, clinical data safety, and data management. Poland's participation in EU initiatives such as the European Health Data Space (EHDS) should be used to increase interoperability and support joint innovation. Furthermore, integrating space technologies, wearable devices, and NLP tools into national projects demonstrates Poland's potential to become a regional leader in applied digital health innovations. Despite this progress, the integration of telemedicine remains uneven across different specialties and geographical regions. Disparities in access to digital technologies persist between urban and rural areas, and many digital tools remain in the pilot phase or are used only to a limited extent. Therefore, overcoming the remaining barriers and research gaps is necessary to ensure sustainable scaling, implementation of a scientific framework, and long-term research of the results. Specializations, such as orthopedics and pathology, despite their historical contribution to early pilot telemedicine studies in Poland, did not show significant progress in the use of digital technologies in Polish healthcare between 2014 and 2024. This stagnation may be due to infrastructure limitations, limited reimbursement frameworks, and lower perception of the feasibility of remote diagnostics in these specialties. In the current period of the global expansion of AI-assisted image analysis and tele-imaging platforms, targeted national initiatives could accelerate their integration into routine orthopedic examinations and pathological processes. AI-based radiological interpretation tools could enhance musculoskeletal diagnostics and digital pathology systems could facilitate centralized expert consultations, which would be particularly beneficial for regions with limited access to services in these specialized fields.