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INDICATE: what is federated data analysis?!

What is INDICATE?

Healthcare institutions possess vast amounts of untapped data that could drive innovation and improve patient outcomes. As much as 97% of health data world-wide is not re-used. With INDICATE we aim to unlock this potential by building a federated data infrastructure for Intensive Care Units (ICUs) across Europe.

But how can you analyze data without accessing it directly? The answer lies in INDICATE’s design, specifically in its first development phase due for delivery in August 2025. 

What is Federated Data Analysis? 

Federated Data Analysis allows researchers to run analyses across multiple ICU datasets without seeing the raw data. It is a code-to-data scenario to facilitate secure computation.

INDICATE’s federated analysis architecture enables data users, such as researchers, innovators, and policy makers, to derive insights from ICU data across multiple institutions, regions, and European countries.  

How is INDICATE designed to make Federated Data Analysis possible? 

In the beginning of the project, the architecture will consist out of four essential components that work together to enable federated observational studies: 

  1. Metadata catalog 
  2. Study repository 
  3. Secure processing environment 
  4. Aggregated results exchange 

Metadata Catalog 

The metadata catalog is usually the starting point for a researcher who has an idea. It enables researchers to discover what data, standardized and in a common format, is available across participating hospitals without accessing the data itself. Similar to browsing a library catalog that shows book titles and summaries without revealing the books’ contents, researchers can see what types of ICU data exist and where, allowing them to design appropriate studies.  

Study Package and Study Repository 

The study repository manages the lifecycle of Study Packages. A Study Package is a collection of files, such as a research protocol, scripts, and data requirements that are used to answer a research question. Think of it as a library or GitHub repository where researchers can submit their study proposals.  And other researchers and data providers can review the proposals, raise issues, and provide feedback. Once a researcher is happy with their proposal, they obtain ethical approval for the study. Next, the researcher can invite Data Providers to join the study. Data Providers are hospitals that participate in INDICATE and make their data available. The researcher’s institute and the Data Providers will need to enter into a Data Sharing Agreement. This Agreement includes the data processing purposes, the legal basis for processing, and how intellectual property rights are handled. After the Data Sharing Agreements have been signed, the Study Package is locked. It is now ready for download. 

Secure Processing Environment 

The secure processing environment is where the analysis of personal health data occurs. The health data stays within the hospital setting. This means that the hospital downloads the Study Package from the Study Repository and installs it in their Secure Processing Environment. The Study Package is executed against the hospital’s data. Think of the secure processing environment as a clean room where an analysist performs experiments the researcher told them to do without taking anything outside, except the results.  

A data steward at the Data Provider is responsible for downloading the signed Study Package. They verify it is the correct version. Next they install and run the package and check for errors. If the package executed correctly, the data steward verifies the Aggregated Results. It is also their job to verify that there are no personal data remaining in the Aggregated Results. If all checks are passed, the data steward uploads the Aggregated Results to the Aggregated Results Exchange. 

Aggregated Results Exchange  

The aggregated results exchange enables the secure sharing of aggregated outputs from the analysis. Aggregated results include statistical summaries, such means, standard deviations, frequencies and proportions, but not individual patient data. It is like the airlock to the clean room where the results may be placed for pick-up, without the being able to enter the clean room itself.  

After Aggregated Results have been uploaded to the Aggregated Results Exchange, the researcher is notified that new results are available. They can log in and download the Aggregated Results. Next, the researcher can combine all of the Aggregated Results from all participating Data Providers into one pooled result. This pooled result can be used for a scientific paper, for example. 

Data Protection, Privacy and Security in INDICATE 

INDICATE architecture implements privacy by design principles, maintaining data sovereignty as a core requirement. Personal data of patients always remains within the hospital, and only aggregated results leave the hospital’s environment after review. 

This approach aligns perfectly with General Data Protection Regulation (GDPR) requirements and physician-patient confidentiality by ensuring that: 

  • Data providers (hospitals) retain complete control over their data
  • Personal data remains within the hospital’s security boundaries
  • Only non-sensitive, aggregated statistics are shared, such as averages, and counts
  • All processing occurs with appropriate legal bases and safeguards 

Real-world applications 

INDICATE’s first set of deliverables will result in a Minimal Viable Product that supports observational studies across European intensive care units. This way INDICATE provides immediate value through applications such as comparative effectiveness research and quality benchmarking. In comparative effectiveness research treatment approaches across different hospitals can be compared to identify best practices. Quality benchmarking allows hospitals to compare their performance metrics with peers while maintaining data privacy. 

For hospital executives, this means gaining valuable insights without the compliance risks of traditional data sharing. For start-ups developing healthcare solutions, it provides access to a broader evidence base for validating innovations without the hurdles of data transfer agreements. 

Moving forward 

INDICATE’s Minimal Viable Product (MVP) is scheduled for completion in August 2025. This foundation will later expand to include federated machine learning (Plateau 2) and decision support capabilities (Plateau 3). 

By joining INDICATE, partners like healthcare institutions can contribute to and benefit from a European-wide approach to collaborative research while maintaining full sovereignty over their data. The architecture provides the security, privacy, and governance needed to unlock the value of ICU data for better patient outcomes across Europe. 

The future of healthcare research lies not in centralizing data, but in federating insights—allowing knowledge to flow while keeping sensitive information secure. 

We would love to hear your thoughts on INDICATE’s design, so feel free to reach out to us via email or our LinkedIn page!

Work Package 5 in Brussels with European Parliament

A big day for INDICATE in Brussels: Wednesday 25 June was a great day for communication and collaboration. Workpackage 5 of INDICATE started the morning with a productive meeting about communications, and in the afternoon, a delegation of INDICATE, including Maurizio Cecconi – Maria Theodorakopoulou – Margo van Mol and Joel Alexandre, met with members of the European Parliament.

INDICATE was highlighted as a strong example of what European collaboration and innovation can look like in healthcare. Our approach to building a federated data platform enables us to share knowledge across borders, support AI development, and still protect patient privacy, which is a crucial balance in today’s data-driven world.



As Maurizio put it: “Research is essential to improving patient outcomes, but without sharing information, we cannot progress. By building a Federated Data Platform and opening it up on a European level, we can safeguard patient privacy while still sharing valuable knowledge that benefits clinicians, researchers, and patients alike. To truly unlock the power of AI and innovation in intensive care, we must share data not only across Europe, but potentially on a global scale, always with privacy and trust at the core.”

It was encouraging to see genuine interest from both European Parliament and Commission representatives. We’re proud to be part of this conversation and part of a project that shows how responsible innovation in AI can move healthcare forward.

INDICATE represented at international 3CT Workshop in Washington, DC

Christian Jung, coordinator of the European INDICATE project, represented our European consortium on Thursday 26th of June at the 3CT Workshop in Washington, DC. The 3CT (Critical Care Clinical Trialists) Workshop is an international think tank focused on clinical research in intensive care.

Participants, including intensivists, pulmonologists, cardiologists, emergency physicians, clinical trialists, principal investigators and statisticians from academia, R&D pharma, NIH, EMA, FDA and PMDA, come together to discuss trial design, implementation, ethics, and data interpretation.

The 2025 edition of the meeting, held June 26 – 27 at the French Embassy in Washington, addressed shared challenges in the field of critical care research.

Through Christian’s participation, INDICATE was able to present its work about the importance of federated data in intensive care on a global stage and engage in valuable discussions with key stakeholders from academia, industry, and regulatory bodies.

Introducing the Principal Architect for INDICATE

We’re excited to welcome Arie as the Principal Architect for our European data infrastructure project, INDICATE!

His experience as Cloud Architect & Lead Architect with complex, large-scale data environments is a tremendous asset to INDICATE.

In this role, Arie supports the Technical Lead in the development of the Enterprise Architecture of INDICATE. He designs and reviews the business, data and application, technology, and security architecture of INDICATE. In addition he helps planning and governance of the deployment of the federated data infrastructure.

With Arie on board, we’re taking another strong step toward building a future-proof European data infrastructure. Welcome, Arie!

INDICATE Newsletter May 2025

We are very excited to announce the INDICATE External Expert Advisory Board and the INDICATE Ethics Advisory Board! These experts bring a wealth of knowledge and experience to our project.

These boards play a key role in guiding INDICATE towards patient-centered, ethically responsible, and trustworthy data use in healthcare.

  • Strategic guidance – Offering expert insights to align the project with cutting-edge clinical, ethical, and scientific standards.
  • Specialized expertise – Supporting technical and clinical progress in areas like ICU care, AI, and data science.
  • Community connection – Linking INDICATE to key networks (clinical, start-ups) and research communities to foster collaboration.

Establishment of the Data Protection Workgroup

A nurse wearing full personal protective gear or PPE because of the COVID19 pandemic tending to something or someone off screen.

The INDICATE Data Protection Workgroup has been established. The responsibilities and tasks include:

  • Data security and privacy – Oversee the design and implementation of the project’s data management processes, ensuring strong data protection and privacy protocols. 
  • Regulatory compliance – Advise on compliance with the General Data Protection Regulation (GDPR) and other relevant national or European data protection laws. 
  • Risk assessment – Identify potential data security risks, propose mitigation strategies, and support the development of safe data-sharing infrastructures across European ICUs.

Erasmus MC Contributes to WHO Accreditation for TU Delft

With the support of the AI Ethics Lab at Erasmus MC – co-founded by internist-intensivist Michel van Genderen, Project Coordinator of INDICATE – TU Delft Digital Ethics Centre is accredited by the World Health Organization (WHO). From now on, the centre will advise the WHO on ethical aspects and regulations regarding AI in healthcare.

“AI has great potential to transform healthcare, but that can only happen if what we do is done right,” said Michel van Genderen.


Establishment of the Data Provider Support Workgroup

The INDICATE Data Provider Support Workgroup has been established. The responsibilities and tasks include:

  • Provide technical and legal support to Data Providers (hospitals making their data available through the INDICATE infrastructure) in setting up the ETL process and establishing data quality assurance and data quality control policies. 
  • Monitor data quality and GDPR compliance after the initial onboarding of Data Providers, in close collaboration with the ELSI experts in WP3.
  • Develop and implement a structured monitoring plan to continuously monitor relevant KPIs for INDICATE, including the progress of Data Providers onboarding and the volume of data made available through the INDICATE infrastructure.
  • Implement data audit procedures based on those developed in IMI EHDEN and outlined in the OHDSI handbook.

Celia Alvarez-Romero

Servicio Andaluz de Salud

Who am I?
I am Celia Alvarez-Romero and I am the leader for Work Package 2.

I have a PhD in Molecular Biology, Biomedicine and Clinical Research from the University of Seville. I am a researcher of the Computational Health Informatics Group at the Virgen del Rocío University Hospital, as part of the Andalusian Health Service (SAS) in Spain. I have over nine years of experience as a researcher in medical informatics projects at regional, national and European levels.

What am I up to during INDICATE?

For the INDICATE project, my colleagues from the SAS team and I are leading Work Package 2 (WP2), which focuses on defining a common data model for INDICATE. 

Our goal is to ensure alignment with internationally recognized standards and vocabularies. In addition, we are contributing our expertise to coordinate WP2 activities and outcomes with other key areas of the project—specifically, the development of the federated infrastructure in WP4, the ethical and legal requirements for data protection in WP3, and the implementation of use cases defined in WP6.

Get in contact!
e: celia.alvarez@juntadeandalucia.es


Tobias Posthumus

KPMG

Since 2017, I work at KPMG to accelerate the digital transformation of healthcare.

My background is in Economics and Business economics, during which I quickly realized that technology (e.g. platforms) enables new ways of collaboration and will have a transformative impact. Then I joined KPMG and quickly came to believe that this digital transformation will have the greatest societal impact in healthcare – as well as face the biggest challenges in healthcare. For me, these challenges are in developing shared visions, (digital) strategies and long-term collaborations (governance and operational models) in complex healthcare ecosystems. I support healthcare organisations and collaborations within healthcare, such as public-private partnerships, regional healthcare collaborations, associations and others.

What am I up to during INDICATE? Connected to which WP? Which cases do I work on?

KPMG is a proud partner of INDICATE, with active participation from various disciplines within KPMG and by our offices in the Netherlands and Poland. Our responsibilities include:

  • Implementation of the technical infrastructure: ensuring that the technology supports all the needs of INDICATE, enabling a secure, trustworthy and federated analysis of data and machine learning, as well as a user-friendly portal.
  • Ownership and governance model: designing and implementing a sustainable governance for the INDICATE ecosystem, that will ensure the continuity of INDICATE after the project ends. This includes the establishment of a new entity under European law.
  • Operational model: designing and implementing the operational model for management of the INDICATE ecosystem, which includes the responsibilities that will be centralized within the new entity and the responsibilities that will be federated/decentralized in the broader INDICATE ecosystem.
  • Other: in addition, we support INDICATE with various (relatively) smaller tasks. Examples are the development of template agreements, supporting the development of business models and assessing the operational maturity of INDICATE at several points in time.

As the project lead for KPMG, I act as the primary contact and coordinate the KPMG involvement within INDICATE. Additionally, I lead the development and implementation of the ownership-, governance- and operational model.

What motivates me to be part of INDICATE?
INDICATE brings together all the aspects of what motivates me in my professional career: collaboration in complex ecosystems, societal relevance and impact, implementing new and innovative concepts, and working with a great team – from various organizations, nationalities and disciplines.

Get in contact!
e: Posthumus.Tobias@kpmg.nl


Falk von Dincklage

Universitätsmedizin Greifswald

I am a professor of anesthesiology and intensive care medicine as well as a medical informatics specialist at University Medicine Greifswald, in north-eastern Germany.

In clinical work I’m the deputy director of our department of anesthesiology and intensive care medicine. In research I lead a scientific work group that focuses on investigating and developing clinical decision support systems and intelligent quality management systems for intensive care medicine.

What am I up to during INDICATE?
I am the lead for the clinical use case ‘Quality benchmarking dashboard’ in which my team and I provide a system to automatically monitor and benchmark the quality of care across participating hospitals. We are also contributing to data standardization as the foundation for an interoperable infrastructure.

Participating in INDICATE provides the opportunity to cooperate with partners across Europe towards the common goal to provide a common intensive care data infrastructure across Europe. Standardizing the intensive care data infrastructure provides the foundation to share software like clinical decision support systems and intelligent quality management systems which ultimately contributes to improve patient care across hospitals in Europe.

Get in contact!
e: falk.vondincklage@med.uni-greifswald.de


We are keen to post a bio of everyone involved in this project on the website and in the newsletter as well! 

Please share:

  • Who am I?
  • What do I do?
  • What am I up to during INDICATE? Connected to which WP? Which cases do I work on?
  • What do you expect to accomplish within INDICATE?

Please share your bio and picture with: maaike@indicate-europe.eu



Michel van Genderen
Co-lead INDICATE
e: m.vangenderen@erasmusmc.nl

Christian Jung
Co-lead INDICATE
e: Christian.Jung@med.uni-duesseldorf.de

Lisanne van Prooyen Schuurman
Project Manager
e: e.vanprooyenschuurman@erasmusmc.nl

Jan van den Brand
Technical Lead
e: a.vandenbrand@erasmusmc.nl


Date: June 5, 2025
Location: De Doelen, Rotterdam, The Netherlands
Spoken language: Dutch

At the Data Driven Healthcare event, you’ll hear all about the latest developments in the field of Healthcare & AI. The question of how to approach this responsibly is essential and will not be left out.

Which challenges in healthcare can we solve with data and AI — and which ones can’t we? How do you approach this? And what are the dilemmas healthcare institutions need to take into account?

In a panel discussion — featuring, among others, INDICATE Co-Lead Michel van Genderen — these topics will be explored. Different perspectives and interests will be represented in the conversation.


Date: September 11, 2025 – September 12, 2025
Location: Hilton Rotterdam, The Netherlands

Artificial Intelligence (AI) continues to impact society in various and profound ways. It is inevitable that health care will face significant changes through the introduction of AI systems that are intended to support the health care system with diagnosis, treatment decision-making, hospital management, medical research and development, nursing care, and the health infrastructure (homecare, insurance etc.) more broadly.

The conference ‘Responsible AI in Health Care’ will clearly map how the introduction of AI in medicine unfolds, which aspects of the health care systems will be impacted most, and how this impact will unfold. First and foremost, it intends to discuss in depth, the question how to shape this transition in a responsible way.


Do you have a special request? Would you like to share news or a publication? Would you like to be (digitally) connected to a certain person? Did you speak or went to an event related to INDICATE or INDICATE-subjects? Please feel very welcome to share your questions or input with: info@indicate-europe.eu

When sharing your news, please make sure to attach your photos/images or figures and always make sure when people are visible, you have their permission to use the pictures.

Below with the format you can use to share your news with us: 

  • What is the purpose of your news? 
  • What title can we use?
  • Who attended (names, roles, if related to INDICATE meetings/events)?
  • What were the main topics discussed or key findings?
  • Were any follow-up actions or appointments agreed upon?
  • Is there anything special or noteworthy?

Milestones

Deliverables


Logo Assistance Publique Hospitaux de Paris
Bērnu klīniskā universitātes slimnīca Valsts Sia (Children’s Clinical University Hospital)
Logo Cradeq B.V.
logo Vereniging EIT Health België-Nederland
Logo Erasmus Universitair Medical Center Rotterdam
European Federation of Critical Care Nursing Association
Logo Fraunhofer Gesellschaft Zur Forderung der Angewandten Forschung
Logo Heinrich-Heine-Univeristaet Duesseldorf - universiteitsziekenhuis Dusseldorf
Logo HELLENIC SOCIETY OF INTENSIVE CARE MEDICINE
Logo Servicio Madrileno de Salud (Hospital Universitario 12 de Octubre)
Logo logo ervicio Andaluz de Salud (Virgen del Rocío University Hospital)
Logo INSTITUT CATALA DE LA SALUT
Logo INSTITUT NATIONAL DE LA SANTE ET DE LA RECHERCHE MEDICALE
Logo Region Stockholm (Karolinska University Hospital)
logo KPMG Advisory NV
Logo Medizinische Universitat Innsbruck
Logo Medizinische Universitaet Wien
Logo Paracelsus Medizinische Privatuniversitat Salzburg
Logo Sorbonne Université (INSERM-SU)
Logo Universitair Medisch Centrum Utrecht
Logo Ghent University Hospital
Logo Logo Univerisitatsmedizin Greifswald Kopperschaft Des Offentlichen Rechts
Logo Université de Rennes

Endorsed by:


Get in contact via e-mail:
Email address: info@indicate-europe.eu
Email address: support@indicate-europe.eu
Email address: indicate@erasmusmc.nl




Establishment of the Ethics Advisory Board

The Ethics Advisory Board members will advise us on ethical issues to ensure that our project complies with ethical standards and regulations.

Ethics Advisory Board members

Atia Cortés, Recognized researcher at the High Performance in AI group of the Barcelona Supercomputing Center (BSC-CNS). Atia specializes in the ethical, legal, socio-economic, and cultural aspects of AI, contributing to various EU-funded projects and initiatives.


Stefan Buijsman, Associate Professor Responsible AI at TU Delft, The Netherlands. Stefan’s research focuses on transparency and explainability of AI, and he leads the WHO Collaborating Centre on AI Governance and the TU Delft Digital Ethics Centre.


Ania Henley, is a Citizens and Patients Involvement Expert Advisor with over 25 years of experience in finance, clinical audits, and research data systems. She advises the NIHR Imperial Biomedical Research Centre for Multiple Long-Term Conditions at Imperial College London, supporting patient-derived quality of care initiatives. She has served as Deputy Chair of the EIT Health Board on Ethical, Legal, and Social Issues, contributing to the Data Saves Lives initiative and the European Patient Forum. At Imperial, she co-chaired the HEALTHYSTATS committee, helping develop a new way to communicate clinical trial results, published in BMJ Open Access, and supported the REACT COVID-19 studies.