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Health insurance covers the entire population of Italy. This encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.).

Public vs private

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The national PHR

History

Fascicolo Sanitario Elettronico (FSE), the Italian National PHR, was introduced from Art. 12 of Law Decree 18 Oct 2012 n. 179. The law established that:

• Each region had to create and implement a PHR by June 20, 2015.

• The user interfaces, systems, and software must ensure full interoperability at regional, national, and European levels.

Even Some regions had started local FSE projects before this law, some regions had already initiated projects to develop local FSEs, such as the Emilia Romagna region (Posteraro, 2021).

In more recent years, Italy wrote, as requested by the EU recovery package Next Generation EU (NGEU), the National Plan of Recovery and Resilience (PNRR), in which each country has to define a plan of reforms and investments for the period 2021-2026. The Italian PNRR was officially approved by the Italian Government on the 13th of July 2021.

The PNRR allocates approximately Italy’s National Plan of Recovery and Resilience (PNRR) allocated 2.5 billion euros for digital health, with 1.3 billion euros dedicated to establishing a national data infrastructure for the FSE. This The infrastructure aims to be homogeneous across the country and to include the entire clinical history of patients. The budget is for 2021-2026 (Permanent Conference for Relations between the State, the Regions, and the Autonomous Provinces, 2022).

Features

Even though all regional Regional Fascicolo Sanitario Elettronico (FSE) systems must adhere to the national minimum standards set by law for data sharing and basic features. However, each region’s FSE is still distinct. As a result, the functionalities of the Italian FSE vary , with variation across regions, making and it challenging is therefore difficult to define a uniform set of features.

According to the legislation, the FSE must include a set of "core" elements, such as The core elements of the FSE as stated in the national legislation include: patient demographics, clinical reports (e.g., specialist visit reports, test results, radiology), A&E reports, discharge letters, organ donation consent, a patient summary, and a pharmaceutical dossier.

The pharmaceutical dossier is updated by pharmacies and . It helps track a patient's medication history, assess the appropriateness of new prescriptions, and monitor adherence to therapies. However, this feature is still underdeveloped in many regions.

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• Patient ability to add notes and clinical documents, which promotes self-management and empowerment. Some argue that this should become a core feature.

• In-home assistance programs.

• Care plans.

• Medical certificates.

• Vaccination records.

Recent legislation, the Decreto Rilancio (2020), mandates the integration of the FSE with other national systems, including:

• The Transplants Information System (Sistema Informativo Trapianti - SIT), a digital platform for managing data related to the National Transplants Network.

• The Italian Vaccine Registry.

• Regional appointment management systems (CUPs).

(Posteraro, 2021)

Challenges and areas for improvement

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As of the third trimester of 2023, nearly all Italian citizens had have activated their Fascicolo Sanitario Elettronico (FSE), with 57.66 million users out of a total population of 58.85 million. However, login and usage rates remain low.

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• In 10 regions (including one autonomous province), no healthcare facilities contributed data to their citizens' FSE.

• In six regions, less than 60% of healthcare facilities participated.

• Only in four regions did more than 60% of facilities add data to the FSE.

(AGID Agenzia per l’Italia Digitale, 2023-2024).

As of May 2024, the Government has released new statistics on the percentage of Regions and Autonomous Provinces where the FSE is configured to store specific types of documents. However, while the system is capable of storing these documents, their actual presence in a patient’s record depends on the particular healthcare facility involved. All of them are configured to store: discharge letters, prescriptions, referrals, lab results, imaging results, outpatient appointment reports, and emergency admission reports. More than half also have: pathology reports, patient summaries, vaccination certificates, documents attesting specialist care service have been provided, documents attesting the prescribed medication has been bought, and personal health diary.

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• Permanent Conference for Relations between the State, the Regions, and the Autonomous Provinces ,2022. Digital Health. Presentation to the Permanent Conference for Relations between the State, the Regions, and the Autonomous Provinces, Rome, 2 March 2022. REP. ATTI No. 22/CSR of 2 March 2022. Available at: https://www.statoregioni.it/it/conferenza-stato-regioni/sedute-2022/seduta-del-02032022/atti/repertorio-atto-n-22csr/ (accessed: 29 April 2024).

• Posteraro, N., 2021. La digitalizzazione della sanità in Italia: uno sguardo al Fascicolo Sanitario Elettronico (anche alla luce del PNRR). FEDERALISMI. IT, 2021, pp.1-42. Available at: https://air.unimi.it/handle/2434/946488 (accessed: 29 April 2024).

• World Health Organization, 2022. Italy: health system review. Health Systems in Transition, 24(4). Available at: https://eurohealthobservatory.who.int/publications/i/italy-health-system-review-2022 (accessed: 29 April 2024).

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Emilia-Romagna in Italy