Abstract
BACKGROUND: Digital transformation in healthcare increasingly depends on the digitalisation of day-to-day clinical work, in particular on professionals’ ability to use electronic health records, telemedicine, and data-driven tools. However, gaps in digital competence and uneven access to training persist across Europe. This study examines how healthcare professionals understand and apply digital tools in clinical practice, and compares perceived barriers between Northern and Southern Europe. METHODS: We conducted a cross-sectional qualitative survey using a digital self-assessment questionnaire administered to 2,048 healthcare professionals from six European countries. The study was theoretically grounded in the European Digital Competence Framework for Citizens 2.0 (DigComp 2.0) and the eHealth Literacy Framework, and employed thematic analysis to interpret open-ended responses. RESULTS: Four key thematic areas emerged: remote patient care and monitoring; digital education and health management; transformation of clinical workflows; and data-driven diagnostics. Professionals in Northern Europe—especially Finland—described integrated digital systems, structured training, and institutional support. Participants in Southern Europe more often reported fragmented infrastructure, limited training opportunities, and organizational resistance. The most frequently cited barriers to digital adoption were lack of training (23%), time constraints (27%), limited resources (24%), and resistance to change (19%). CONCLUSIONS: Healthcare professionals widely view digital competence as essential for safe and effective care, but uptake is constrained by structural barriers and regional inequalities. Targeted investment in workforce training, protected time for skill development, and foundational digital infrastructure—particularly in Southern Europe and in resource-limited settings—is needed to support equitable digital transformation across European health systems. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14000-8.