Electronic health record, yes only from 41% of Italians

Only 41% of Italians have given their consent for doctors and health workers to consult the Electronic Health File (Fascicolo sanitario elettronico - Fascicolo sanitario elettronico), a fundamental tool for the digitalisation of the National Health Service (Servizio sanitario nazionale - SSN). But with considerable regional differences, almost abysmal: from 89% in Emilia-Romagna to just 1% in Abruzzo, Campania, Calabria and Molise. In the south, moreover, only Apulia with 69% exceeds the national average. This, in short, is what emerges from the Gimbe Foundation's report on the ESF, presented at the 19th Risk Management Forum in Arezzo.

The report speaks of real 'digital fractures' both in terms of services offered and use by citizens and health professionals. "The Electronic Health Record," says the president of the Gimbe Foundation, Nino Cartabellotta, "is not only a tool with which citizens can track and consult their health history, but also represents a strategic lever for improving accessibility, continuity of care, and integration of health and social-health services. However, to date,' he points out, 'significant regional inequalities persist, depriving many citizens of the same opportunities for access and use. Moreover, the lack of harmonisation of the ESF risks leaving citizens without access to data that are essential for their health when moving between regions'.

In fact, the data, updated to 31 August 2024 and extracted and processed by the Fascicolo Sanitario Elettronico 2.0 portal of the Ministry of Health and the Department for Digital Transformation, show that the completeness of the documents and services available in the ESF and its use vary significantly between regions. "To date," Cartabellotta explains, "only seven types of documents are accessible throughout the country: hospital discharge letters, pharmaceutical and specialist prescriptions, laboratory, radiology and outpatient specialist reports, and emergency room reports. Latium is the only Region that includes in the ESF all the types of documents required by the decree, while the other Regions show varying levels of completeness: from 94% in Piedmont to 63% in Marche and Apulia. Strong differences also exist on the services front: currently, 37 services are available in the regional ESFs (from the payment of co-payments and services to the booking of visits and examinations, to the choice of a general practitioner or the consultation of waiting lists), :but only Lazio (67%) and Tuscany (64%) exceed the 60% threshold. At the other extreme, in Abruzzo and Calabria, the services accessible through the ESF stop at 8%. Between June and August 2024, then, only 18% of citizens consulted their ESF at least once. "The limited use of the ESF by citizens, particularly evident in the southern regions," Cartabellotta comments, "underlines the urgency of investing in digital literacy.

Disparities between the regions also exist for the use of the ESF by specialist doctors, with 76% of the specialist doctors in the health authorities authorised to consult it. The percentages range from 0% in Liguria to 100% in Lombardy, Molise, the Autonomous Provinces of Bolzano and Trento, Piedmont, Apulia, Sardinia, Tuscany, Valle d'Aosta and Veneto. "To reduce inequalities," Cartabellotta adds, "a new national pact for digital health, involving the government and regional administrations, is indispensable. Without a national integration plan, we risk generating new inequalities, ending up excluding the very people who should benefit most from the digital transformation: the elderly, lonely people, residents in isolated or disadvantaged areas, and people with a low socio-cultural level'.