The Electronic Health Record is a chapter of crucial importance in the evolution of digital healthcare in Italy. It’s a tool that promises, at least on paper, to revolutionize the way patients interact with the healthcare system and doctors manage medical information.
But it goes beyond the simple digitization of data: thanks to integration with the most advanced technologies, such as artificial intelligence and big data analysis, it could represent a real leap in quality for the efficiency of our healthcare system. However, the implementation status of the project on the national territory is at a standstill: many challenges still need to be addressed to ensure full operation.
Electronic Health Record: the features coming soon
The Electronic Health Record (EHR) represents a significant transformation in healthcare management in Italy. With an implementation expected to be completed by June 2026, this digital system is set to revolutionize access to healthcare services for citizens.
By the end of 2024, the ESF will integrate advanced features such as the payment of health tickets, the booking of visits and tests, the choice or revocation of the doctor, and the consultation of reports. These new features are part of a broader plan which aims to make the ESF a daily tool for citizens, facilitating simpler and more direct access to medical care.
The goal is also to make the system internationally interoperable, thus allowing the use of the health record even outside national borders.
The security of the Electronic Health Record and the role of general practitioners
All these developments should be supported by rigorous security protocols that guarantee privacy of user data.
The involvement of general practitioners is essential in this transition phase. Specific training activities are planned for over 50,000 general practitioners, which will help to use the ESF effectively, reducing bureaucracy and improving the quality of time spent with patients.
This “de-bureaucratization” is vital to lighten the administrative workload and increase efficiency in the treatment of patients. The effectiveness of the ESF is not limited only to improving access to health services; it also aims to create a more efficient and less expensive healthcare system.
The Electronic Health Record and healthcare efficiency
The homogeneity and interoperability of the data contained in the ESF are fundamental to guarantee timely responses to health needs throughout the national territory. The government strategy also provides an information campaign and regional meetings to promote the adoption and use of the ESF.
The ESF can be seen as the engine of a digital revolution in Italian healthcare, with the potential to significantly improve citizens’ daily lives and health management at a national level. Collaboration between doctors, health facilities, pharmacists, and the active participation of citizens are essential to fully realize the promises of this ambitious project.
The creation of the electronic health record which is continuously enriched also with the monitoring of values detected remotely it is an irreplaceable tool for a modern healthcare system because it contributes to making many pathologies diagnosable at a very early stage, to identifying risk situations, to managing assistance and treatment remotely.
Technology constitutes the fundamental means to meet the needs of a continuous remote assistance service, to be built around the patient, based on the existing pathology. Continuous monitoring will allow the timely identification of critical issuesallowing the adoption of interventions and corrective measures before more serious complications appear, with positive consequences for both the patient and the healthcare system in terms of cost reduction.
With big data and AI, medicine becomes predictive and preventative
The possibility of using big data and artificial intelligence overturns the main epistemological assumption of contemporary clinical practice, i.e. Evidence-Based Medicine (EMB), i.e. “the process of research, evaluation and systematic use of the results of contemporary research as a basis for clinical decisions”. With the use of big data and artificial intelligence, however, medicine is born based on what is not evident to the individual human doctor, but can become evident with the use of big data and deep learning techniques as capable of considering and processing much more information than is possible for a human being.
Today with the use of big data in healthcare and deep learning techniques we are able to carry out effective predictive and preventive medicine long before the appearance of symptoms and for chronic and worsening pathologies this constitutes a significant advantage.
Instant access to the entire data set allows you to predict the evolution of the clinical picture through decision-support algorithms that make the entire process more efficient.
All of this can be achieved by emphasizing the constructivist nature of the process, aimed at bringing a significant advantage to all stakeholders involved in the individual’s care and assistance process. Health monitoring, prevention of critical situations and support for daily activities therefore represent an emerging application area at a healthcare level, with particular reference to frail, elderly people and those with chronic pathologies.
The state of implementation of the ESF in Italy
It seems appropriate, however, at this point to make some considerations on the state of implementation of the Electronic Health Record in Italy, in particular by comparing what has been done in the last 6-9 months not only in the pilot regions and in relation to the areas of intervention of the pilot projects to which the previously exposed data refer, but in the overall national project concerning the creation of the Electronic Health Record.
To do this we can use data on the implementation status and use of the Electronic Health Record.
If we look at the data on the state of implementation, the situation would even seem idyllic: All regions exceed 90% of implementation and the majority declares 100% implementation, but in reality the implementation of the electronic health record, looked at on a national basis, is in a phase of stagnation.
The positive data presented referred to individual aspects of regional projects which, however, did not change the picture of substantial immobility at a national level.
To date, the state of implementation of the health file in Italy is managed by the regions in an uneven manner, which could also lead to a non-intercommunicability of data.
ESF, still a mirage for too many citizens
In Italy, therefore, the electronic health record today is a mirage for a significant number of citizens. Even the regions that have launched projects in this field have not always taken due account the need for interoperability in data exchange.
Without electronic health records, not only do advanced healthcare 4.0 applications become impossible, but normal healthcare procedures also lose their effectiveness. The great difficulties that many regions have had in implementing an effective vaccination strategy are caused by this lack of digitalisation.
If we had a national electronic health record management system, we could have proceeded with the vaccination by calling individual citizens by name and based on priorities, knowing in advance which were the most fragile, going to vaccinate those who were unable to travel at home. We would therefore have speeded up the procedure and avoided the cost of using booking platforms external to the healthcare system.
The need to end the fragmentation of health policies
The gaps in the introduction into the Electronic Health Record, as well as the technological gap in Italian digital healthcare, can be traced back to regional fragmentation of health policies. A regional health system managed and governed by 19 regions and two autonomous provinces has produced the sick fruit of a poor innovative capacity, a management that is more attentive to budgets than to the real needs of citizens with the side effects of widespread corruption and illegality which in a generalized manner they have affected all regional health systems. A recent research (Marino D., Priolo M., “Health Governance in Italy after the Title V Reform, constitutional conflicts and regional gaps, published in “Political Economy”) has highlighted all the critical issues of regionalized healthcare .
Regionalized governance of this type can only widen regional healthcare gaps and the substantial flop, at least to date, in the implementation of the electronic health record is none other than one of the most evident failures. All that remains is to hope that the impulse given by this latest decree can finally shake up the system in order to start the process of digital transformation of Italian healthcare.
