From transaction to transformation: a binational perspective on integrating community pharmacy into the digital health ecosystem of Southern European health systems.

Background: Community pharmacists (CPs) in the binational Southern European countries of Greece and Cyprus (CG) are among the most accessible healthcare professionals, serving as key points of contact within their health systems; however, despite widespread e-prescription adoption, they remain constrained by limited access to comprehensive patient clinical data. This gap limits their ability to deliver coordinated, evidence-based care and exposes patients to avoidable medication-related harm. Within the evolving framework of the European Health Data Space (EHDS), integrating community pharmacy into national digital infrastructures represents a strategic opportunity for both nations to transition from transactional to transformative practice. This study examines international evidence and policy exemplars to advocate for granting CPs in CG full, role-appropriate, read-and-write access to patients' Electronic Health Records (EHRs), positioning them as integral actors in the digital health ecosystem. Methods: A narrative review of global literature (2021-2025) was undertaken using PubMed, Google Scholar, and institutional sources. Studies and policies were selected for relevance to interoperability, patient safety, and governance. High-impact models, including the UK's read-write EHR pilot, Denmark's Shared Medication Record, and Estonia's national e-health infrastructure, were appraised for transferability to the CG contexts. Findings: International evidence shows that pharmacist participation in interoperable, read-write EHRs enhances medication safety, adherence, and collaboration. Conversely, fragmented or siloed digital infrastructures - such as Greece's limited e-prescription platform or the underutilised national electronic health record system in Cyprus - fall short of enabling genuine clinical integration and coordinated, patient-centred care. A phased roadmap for both countries includes legal recognition of CPs as authorised EHR users, HL7-FHIR-based interoperability, and workforce training in digital competencies. Embedding pharmacoepidemiological indicators in pilots will yield measurable improvements in safety, efficiency, and adherence. Conclusion: For Greece and Cyprus, granting CPs interoperable EHR access is not just digital progress but structural reform, fully integrating pharmacy into Southern Europe's digital health ecosystem.