All our health in one click. Here are the new guidelines for the electronic health record: from verifying diagnoses and therapies to paying for visits and telemedicine

by Luciano Fassari

Both the technical indications and a decree indicating the objectives to be achieved in order to obtain the resources (a total of 610 million) arrive on the table of the Regions. But the new ESF will not only be useful to citizens: doctors will be able to access and use patients’ clinical data and share information and consult other professionals. Pharmacists will be able to consult the therapy information sheet in real time and verify the therapy delivered to the patient. But also nurses and other healthcare professionals will be able to access the clinical data of the following patients. THE GUIDELINES – THE RESOURCES DECREE


Consult your clinical data, book and pay for services, access Telemedicine services, receive information on your pathology on the care pathway to follow. These are some of the services that Italian citizens will be able to find in their electronic health record. The new national guidelines drawn up by the Ministry of Health in collaboration with the Ministry of Technological Innovation and Digital Transition and the Ministry of Economy and Finance outline the path to be taken by 2026.

The new ESF will not only be useful to citizens. For example, family doctors, pediatricians and specialists will be able to access and use the clinical data of patients undergoing treatment and also share information and consult with other professionals.

At the ESF, too, pharmacists will then be able, among other things, to consult the therapy information sheet in real time and check the therapy delivered to the patient. But also nurses and other healthcare professionals will be able to access patients’ clinical data to the extent of their relevance.

But the ESF will also be useful to institutions for analyzing and monitoring demand and planning the supply of services.

The project falls within the framework of the Pnrr for which approximately 610 million are allocated as provided for by another ministerial decree which links the allocation of resources to the presentation by the Regions of operational plans (within three months) which will be monitored by the competent ministries with the support of Agenas, which can replace the Regions in the event of default.

The Regions will now have to express themselves on the two measures.

But let’s return to the guidelines which for the Government “intend to summarize and modify all the previous recommendations and become the basis for implementation in the period 2022-2026”

For the document, the ESF must become “the citizens’ single and exclusive point of access to NHS services, an ecosystem of data-driven services for healthcare professionals for the diagnosis and treatment of their patients and for increasingly personalized care of patients”. , a tool for health structures and establishments that will be able to use clinical information from the FSE to carry out analyzes of clinical data and improve the supply of health services”.

To date, in fact, the Electronic Health Record (EHR) “does not yet provide an accurate representation of the patient’s state of health, the socio-health context and social protection plans. In addition, it is not fed in the same way in all Regions, which greatly limits its usefulness as a tool for diagnosis, treatment and prevention”.

To strengthen it, the Guidelines define 4 lines of action to strengthen the ESF:

– ensure seamless and uniform digital health services

– standardize content in terms of data and adopted codes

– strengthen the architecture to improve the interoperability of the ESF

– strengthen the governance of the rules for implementing the new ESF.

For each of the 4 dimensions (services, content, architecture and governance), on which the action orientations outlined by the Guidelines act, the mandatory and recommended requirements to be implemented in the short, medium and long term to pursue the objectives are defined. underline.

Mandatory requirements to be implemented in the short term, to (i) standardize at national level the already existing services of the ESF for citizens and health professionals, (ii) extend the minimum base of mandatory documents of the ESF and improve their standardization as well as that of the additional documents already implemented by the Regions, (iii) develop the ESF interoperability infrastructure through the creation of a national index, a national patient register and a component for acquiring data and documents from their systems producers, (iv) adopt a system for monitoring and monitoring the quality of information that feeds the FSE institutionalize and govern the standardization processes at the national level of the different dimensions of the FSE

Mandatory prescriptions to be implemented during the duration of the PNRR, to (i) evolve towards services for access to clinical data (and no longer just documents) by citizens and health professionals, for their use in the prevention and treatment activities carried out by general practitioners/PLS and medical specialists, for their use by pharmacists to fulfill their respective functions of verifying adherence to therapies and possible adverse effects, for their use by health establishments for health planning and prevention, (ii) supplying the ESF with standardized clinical data through the use of coding systems and dictionaries, acquired in the prevention, diagnostic and treatment activities carried out by health professionals on patients, including patient sheets produced by general practitioners/PLS according to the objectives of the PNRR, telemedicine data, patient data generated by man and imaging, (iii) implement a new FSE architecture, supplemented by a central repository of clinical data at the HL7 FHIR standard (possibly also reusable at local level) and reinforced by new interoperability components capable of ‘reach and connect all information-producing healthcare institutions, (iv) adopt advanced analytics tools, also based on artificial intelligence techniques for ESF clinical data processing, (v ) to make clinical data available for research, (vi) to institutionalize at the national level a continuous and systematic process of verification of information needs and standardization of documents and clinical data to be merged into the FSE in addition to those initially planned.

Recommended requirements to (i) create services based on clinical data, extended to omics, genetic and epigenetic data, for increasingly personalized customer care, (ii) make Health Institutions available for government purposes, (iii) expand the data available for research on omics, genetics and epigenetic data.

How the ESF will work for citizens, healthcare professionals and institutions

– Consultation of clinical data
– Management of powers of attorney to caregivers
– Access to health services: – Reservation and payment of services, – Delivery of medication, – Telemedicine, – Emergency-emergency
– Autonomy in care: – Information on the pathology – Information on the course of care – Tools to make the patient an actor in the treatment

Services for general practitioners / PLS and specialist doctors

– Access and use of clinical data of patients under treatment
– Dynamic and intelligent ESF summary sheet of the person being helped
– Sharing of information and consultation between healthcare professionals
– Reservation of services
– Support for the application of prescriptive adequacy principles in the care process
– Management and monitoring of patient care compliance
– Primary and secondary prevention

Services for pharmacists:

– Reservation of health services;
– Real-time consultation of the therapy information sheet and verification of the therapy delivered to the patient
– Registration of allergies and adverse drug reactions
– Support for the evaluation of therapeutic adherence

Services for nurses and other health professionals

– Access to clinical patient data as relevant

Health facilities

– Health planning: analysis and monitoring of demand and planning of the service offer
– Access to data and analysis tools to support the prevention services of research institutes

Extraction, pseudo-anonymization/anonymization and preparation of ESF administrative and clinical data for:

– Advanced analytics for data exploration and identification of hidden patterns
– AI/ML model training
– Predictive models for the study of pathologies and therapies

Luciano Fassari

April 15, 2022
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