{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:53:17Z","timestamp":1784875997592,"version":"3.55.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FederatedHealth"},{"DOI":"10.13039\/501100024772","name":"Nordic Innovation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100024772","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Research Council of Finland","doi-asserted-by":"publisher","award":["372505"],"award-info":[{"award-number":["372505"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine real-world barriers to implementing federated learning in healthcare and highlight the organizational, regulatory, and socio-technical factors often overlooked in technical research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Insights were derived from a 3-year implementation of a Nordic\u2013Baltic federated health data network involving 5 countries and 9 institutions, incorporating legal, organizational, and cross-disciplinary perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Structural challenges included coordination burdens, divergent interpretations of privacy and risk, epistemological gaps between disciplines, and the absence of legal frameworks for multi-country distributed learning in Europe. These constraints limited progress despite the availability of robust technical solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Technical privacy measures alone cannot replace trust-building, governance development, and cross-disciplinary translation work. Federated learning is more accurately understood as a socio-technical collaboration model rather than a purely technical architecture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre-implementation planning, tiered participation models, and strengthened governance are essential to support equitable, sustainable, and clinically impactful adoption of federated learning in healthcare.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocag047","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:45:54Z","timestamp":1774615554000},"page":"1236-1240","source":"Crossref","is-referenced-by-count":2,"title":["Federated learning\u2019s uncomfortable truth: why human networks matter more than neural networks"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5740-6480","authenticated-orcid":false,"given":"Laura-Maria","family":"Peltonen","sequence":"first","affiliation":[{"name":"Department of Health and Social Management, University of Eastern Finland , Yliopistonranta 8, P.O. Box 1627, FI-70211 Kuopio,","place":["Finland"]},{"name":"Faculty of Medicine, University of Turku , Kiinamyllynkatu 10, Turku 20520,","place":["Finland"]},{"name":"Turku University Hospital , Kiinamyllynkatu 4\u20138, Turku 20520,","place":["Finland"]},{"name":"Kuopio University Hospital , Puijonlaaksontie 2, Kuopio 70210,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3603-175X","authenticated-orcid":false,"given":"Taridzo","family":"Chomutare","sequence":"additional","affiliation":[{"name":"Technology and Artificial Intelligence Department, Norwegian Centre for E-health Research, University Hospital of North Norway , Postbox 100, Troms\u00f8 9038,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026052218564033100_ocag047-B1","doi-asserted-by":"publisher","first-page":"268","DOI":"10.3233\/SHTI250326","article-title":"Barriers and facilitators for federated health data networks: lessons learned from a Nordic-Baltic experience","volume":"327","author":"Babic","year":"2025","journal-title":"Stud Health Technol Inform"},{"key":"2026052218564033100_ocag047-B2","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.3233\/SHTI251037","article-title":"Implementing a Nordic-Baltic federated health data network: a case report","volume":"329","author":"Chomutare","year":"2025","journal-title":"Stud Health Technol Inform"},{"key":"2026052218564033100_ocag047-B3","doi-asserted-by":"publisher","first-page":"101481","DOI":"10.1016\/j.xcrm.2024.101419","article-title":"Federated machine learning in healthcare: a systematic review on clinical applications and technical architecture","volume":"5","author":"Teo","year":"2024","journal-title":"Cell Rep Med"},{"key":"2026052218564033100_ocag047-B4","doi-asserted-by":"crossref","first-page":"2300695","DOI":"10.2807\/1560-7917.ES.2024.29.38.2300695","article-title":"The potential of federated learning for public health purposes: a qualitative analysis of GDPR compliance, Europe, 2021","volume":"29","author":"Lieftink","year":"2024","journal-title":"Euro Surveill"},{"key":"2026052218564033100_ocag047-B5","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s13690-022-00866-7","article-title":"Enablers and barriers to the secondary use of health data in Europe: general data protection regulation perspective","volume":"80","author":"Vukovic","year":"2022","journal-title":"Arch Public Health"},{"key":"2026052218564033100_ocag047-B6","volume-title":"Proposal for a Regulation on the European Health Data Space. 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