Tag Archives: e-Health

Electronic medical records and patients: a love and hate relationship.

What’s the status of e-health in Italy?

A fairly reliable benchmark may be represented by the implementation of the Electronic Medical File (Fascicolo Sanitario Elettronico) (“EMF”). The EMF was first introduced by Law Decree nr. 179 of 2012, as converted into law no. 221 of 2012; it was then implemented by way of Ministerial Decree dated September 3, 2015. The purpose of the EMF is to provide a tool to patients and healthcare professionals by collecting and providing web access to health-related data like hospitalizations, medical checks, drug administration, home assistance, and access to emergency rooms. In other words, the EMF promises to make all data relating to patients’ health readily available and accessible from any place in the world at an unparalleled speed.

Despite the intents, the new comprehensive tool is far from reaching the expected success.

Why that?

A legal-related reason may lie in the privacy concerns that the creation, population and maintenance of EMFs bring about. EMFs are in fact populated with data collected by healthcare professionals in the course of patients’ lives. The fear that data may be inadequately protected on the internet, and thus inappropriately divulged, may in fact push patients to deny their consent to the creation and population of EMFs. After all, although data are supposed to be processed in accordance with the provisions of the Code for the Digital Administration, and appropriate measures must be taken in order to ensure access authentication and authorization, suspicion may still populate patients’ mind as to the safety of the data processing.

Quite interestingly, a more common reason seems however to prevail. Italians just do not know about the EMF! According to a survey carried out by the Observatory for Digital Innovation in Health on a sample of 1,000 citizens, 83% of them has never heard about the EMF before, 88% ignores if such service is currently active in their Region, and 95% has never sought information about it[1]. Also, EMF seems not to be the most appealing item in blog discussions: out of 400,000 comments on e-health on the web, only 11% relates to the EMF[2]. Such a low impact seems to go hand in hand with quite a low use of other e-health services provided by hospitals and other health-care centers. Only a few patients seem in fact to have taken advantages of services like on-line booking of medical checks, testing records, and payments[3].

If, as mentioned, psychology plays a major role in the implementation of the EMF, so do the efforts thus far made by Regions and healthcare professionals. An inquiry into the implementation of the EMF in the Emilia Romagna Region reveals that not all services set forth in the law are currently included in the available EMF, and the availability of the services may depend on where the interested patient resides[4]. Also, hospitals and healthcare professionals seem to be responsible for having passively accepted the EMF, without truly understanding its potential[5]. Health-care professionals are reported to oftentimes look at the EMF as a burden rather than a revolutionary tool[6]. Lastly, many hospitals and healthcare centers keep on maintaining their independent presence on the web in parallel; as a consequence, patients rely on their website to use services that would be available on the EMF[7].

What can be done?

Perhaps the EMF would be more popular if patients were able to enjoy it through a mobile app, provided that security concerns are adequately addressed. Patients may thus access the EMF more easily, monitor the processing of the collected data and promptly report any inaccuracy or errors. However, if this suggestion may represent an improvement, it would in any case require further education and promotion through healthcare professionals and healthcare centers.

[1] Il Sole 24 Ore Sanità, September 29 – October 5, 2015, page 10.

[2] Ibidem.

[3] Ibidem.

[4] Il Sole 24 Ore Sanità, October 20 – October 26, 2015, page 8.


[5] Il Sole 24 Ore Sanità, October 20 – October 26, 2015, page 8.

[6] Ibidem.

[7] Ibidem.

Why E-Prescription is an Important Step Towards E-Health

Italian Regions are racing towards the goal of de-materialization of prescriptions of medicines. While the national average percentage of electronic prescriptions has not yet reached 50%, certain Regions are recording percentages above 80% (Veneto, Sicily, Campania, and Aosta Valley), according to the latest data published by Il Sole 24 Ore Sanità on the September 8-14 issue. The goal of 90% of de-materialized prescriptions, which has been postponed to 2016 by Law no. 11 of 2015, is getting closer. E-prescriptions will also have an interesting feature that may prove helpful for certain patients: the validity of e-prescriptions would no longer be limited to a single Region, but would spread to the national level.

What are the advantages of e-prescribing and why is it considered a crucial step towards E-Health? Saving on the cost of paper, as cited by certain commentators, is definitely not the point. E-Health requires costly investments in the field of Information Technology, which will not be easily set-off by money saved on paper!

E-prescriptions actually promise much more substantial benefits:

  • Increase of patients’ safety and error reduction: an electronic system can lead to less mistakes due, for example, to the selection of incorrect or unavailable drug dosages, the duplication of therapies or the misinterpretation of the content of the prescription, the avoidance of mistakes linked to the omission of certain information (e.g., allergies).
  • Better monitoring of appropriateness and control of the cost of therapies: e-prescriptions can be a formidable tool to gather data and keep track of health costs in real time, which may lead to a more efficient control on expenditures at every level. As an example, think about what an automatic alert suggesting more cost effective therapies or an optimization of the current therapy may do for a single patient and for the health system in general.

Let’s keep on counting electronic prescriptions (21 million out of 48 million last June!): they will not be the panacea for the national health system, but they can be a great step forward.

A New e-Health National Plan

A new Agreement on Digital Health (“Patto sanità digitale”) prepared by the Ministry of Health has been submitted to the State and Region Conference in June 2015. The proposed agreement between regions and national government aims at setting forth a precise timetable for the implementation of e-health in Italy and envisages a steering committee in charge of monitoring the status of implementation of the plan.

Among the priorities of the new proposal, the Ministry of Health has indicated the adoption of effective solutions for patient workflow management and patient relationship management, to be achieved through the widespread use of electronic clinical records, telemedicine services and mobile health. According to the plan presented by the government, e-health solutions are key to a deeper overhaul of the national healthcare service in order to increase care outside of hospitals and find more efficient ways of bringing healthcare to patients.

Telemedicine solutions, including remote monitoring and diagnosis, would allow the national health service to bring services to patients in a more efficient way. While a specific piece of legislation addressed to telemedicine services has not yet been enacted, on February 20, 2014 the Italian Ministry of Health issued a set of official national guidelines on telemedicine, which set forth a useful regulatory and technical framework for healthcare authorities and private operators active in the provision of telemedicine services.

Unlike previous guidelines, however, the latest digital health plan also aims at restructuring the use of financial resources devoted to the development of telemedicine solutions, in order to convey funds only to more effective projects capable of fostering the widespread adoption of e-health instruments by other healthcare providers. The government also plans to increase the involvement of private actors in these development projects, through project financing and performance based service contracts.

While it is expected that patients will ultimately benefit from a more efficient model for the supply of healthcare, the government also hopes to rein in spending through a more efficient use of resources and a closer monitoring of test prescriptions and drug consumption, which the new e-health solutions will enable.

What’s New in E-Health? Interesting Developments to Consider.

E-Health is a term often used to describe a relationship established between electronic tools and the art of medicine. The European e-Health Action Plan 2012-2020, for example, describes e-Health as a “mean using digital tools and services for health”, which involves an interaction between patients and health-services providers. Within e-Health, the role of telemedicine is considerably growing.

Regulations and guidelines in the field of e-Health are growing in the Italian jurisdiction, too. In particular:

  1. A new Agreement on Digital Health (“Patto per la Sanità Digitale”) prepared by the Ministry of Health has been proposed to the State and Region Conference in June 2015
  2. New guidelines on electronic health records have been issued by the Data Protection Authority on June 4, 2015; and
  3. An interesting administrative court decision issued on July 10, 2015 set forth innovative principles in the field of digital health supplies to the public administration.

Our next blog posts will explore the above developments, which are set to change certain regulatory aspects of e-Health.

Stay tuned, and happy summer!