## 4 Discussion
### Evolution of Digital Health in Poland
An essential element is the regulation of data management and privacy, including standards compliant with the GDPR, which affects how personal and health data are collected, processed, and shared; a national interoperability framework aimed at standardizing data exchange between hospitals, clinics, and IT providers; consent protocols for data access via IKP and mobile apps; reimbursement and financing mechanisms; systems for the reimbursement of telehealth services by the NFZ, introduced or expanded during the COVID-19 pandemic; public-private financing programs, including support for AI tools, mHealth, and pilot implementations; and EU structural funds used for infrastructure and innovation. Before COVID-19, telemedicine reimbursement by Poland's NFZ was inconsistent. Though telecosunlations were legally recognized after the 2015 Act on Medical Activity amendment, the reimbursement framework remained limited, with services mostly restricted to pilot projects or regional initiatives [19; 35]. The lack of standardized tariffs discouraged widespread adoption. COVID-19 has led to rapid institutionalization of telemedicine reimbursement. In March 2020, full reimbursement for telecosunlations in primary care and selected specialties was authorized with fees equivalent to those for in-person visits. E-prescriptions and e-referrals became mandatory, facilitating remote care workflows, while new codes were introduced for COVID-related telemedicine [35]. Regulatory changes granted telemedicine visits equal legal status. Post-COVID, while emergency measures were reduced, telemedicine reimbursement remained integral to routine care, particularly in primary care (POZ), specialist services, and chronic care management. However, a comprehensive long-term reimbursement policy has not yet been adopted, depending on local interpretations. Unlike Germany and France, Poland lacks quality-based payments for telemedicine metrics and reimbursers for AI-based diagnostics or mHealth tools. In the EU context, Poland followed similar trends, where Germany implemented DigitaleVersorgung-Gesetz (DVG) for digital app reimbursement [210; 211], France maintained teleconsultation reimbursement post-COVID [212], and Nordic countries incorporated telehealth in chronic disease management [213; 214]. Digital spaces also include cross-sector cooperation agreements, such as public-private partnerships (PPPs) between tech startups, academic centers, and hospitals; research grants carried out in collaboration between academia and industry, contributing to the promotion of innovation in artificial intelligence, wearable technology, and remote monitoring tools; space sector alliances covering, among other things, the use of telemetry in extreme conditions; and marine medicine. The professional standards and guidelines established by specialist medical and scientific associations that provide ethical and procedural frameworks must play a key role in implementing telemedicine services. Training and certification policies for healthcare professionals using telemedicine tools are crucial. Over the last decade, Poland's digital health evolution has demonstrated how a mid-income European country can harness legal reforms, policy momentum, and innovation to modernize its healthcare system [20]. Before 2014, telemedicine in Poland was primarily confined to conceptual or small-scale pilot projects, with minimal national coordination [28; 215]. The period from 1995 to 2015 was characterized by specialties such as cardiology, pathology, orthopedics, and medical imaging, with research primarily focusing on technological feasibility rather than clinical outcomes. In contrast, the 2014-2024 decade brought about a profound shift. The legalization of tele consultations in 2015, implementation of mandatory e-prescriptions in 2020, and introduction of electronic referrals in 2018 established a functional policy framework.