If not now, when? The National Recovery and Resilience Plan and the digitalization of the Italian NHS

The study provides an updated overview of the deployment of various investments as of today, under Mission 6 of the PNRR, which aims to make the Italian healthcare system more efficient, innovative, and responsive to citizens’ needs. Also examined are the perceptions of General Managers regarding the role of healthcare companies in this transformation.

The focus is on three main investment areas:

1. Hospital digitalization. €2.8 billion has been allocated to upgrade 280 hospitals to meet top international standards by 2025.
2. Electronic health record (FSE, Fascicolo Sanitario Elettronico). €1.38 billion has been set aside to enhance the FSE system, with the goal of making it the exclusive access point for SSN services for citizens.
3. Telemedicine. The PNRR allocates €1.5 billion to expanding regional telemedicine platforms, aiming to provide remote care for 300,000 patients by 2026.

Researchers conducted a survey in collaboration with the Italian Federation of Healthcare and Hospital Companies (FIASO), involving 54 healthcare organizations. Two separate questionnaires were distributed: one for ICT managers, focusing on technical aspects to assess the level of digitalization, and another for General Managers, evaluating their perceived managerial autonomy.

Survey results indicate a growing uptake in digital clinical and healthcare solutions. For example, 98% of healthcare companies have implemented cybersecurity systems. In addition, 87% have introduced electronic health records, although most hospitals are still in the early stages of the process (levels 0-1 on a 0-7 scale). Here progress is measured by the EMRAM Index (Electronic Medical Record Adoption Model), which the Ministry of Health uses to assess digitalization levels in hospitals receiving PNRR funding.

Regarding electronic records, a transition is underway towards FSE 2.0, a more advanced model that enables structured data collection and easier information sharing. While radiology and lab reports are already widely digitized, the transmission of outpatient specialist reports and discharge summaries still lags behind, indicating that further progress is needed.

As for telemedicine, although 83% of organizations report having adopted some kind of platform (mainly for teleconsultations and televisits) these initiatives remain largely experimental. In the coming months, regions are expected to provide all healthcare companies with dedicated telemedicine platforms, requiring them to set clinical priorities and adopt organizational strategies to fully leverage these tools.

To support digitalization efforts, healthcare companies have implemented various organizational solutions, primarily assigning responsibilities to internal IT departments, though without expanding their teams.

General Managers perceive a balance between competencies and responsibilities at the organizational level but express a desire for greater autonomy in key areas, such as planning digital investments and defining service models.

Healthcare companies must act swiftly—ideally by the end of 2025—to systematically integrate digital solutions while bolstering the necessary organizational capabilities for effective management. This process will vary across organizations, as they are at different stages of digital maturity.

Despite these differences, there is a clear need for strategic guidance and skills development to move beyond mere technological implementation. The role of IT departments and Chief Information Officers must evolve from managing technical systems to leading digital transformation, supporting strategic decision-making at the highest levels.

Finally, a balanced approach between institutional levels is essential. While regional governance models differ (with varying degrees of centralization in investment management and organizational autonomy) only effective coordination between regions and healthcare organizations can ensure successful digitalization at this critical moment for Italy’s SSN.

Paola R. Boscolo, Gianmario Cinelli, Francesca Guerra, Francesco Petracca, Paolo Petralia, & Nicola Pinelli. “La trasformazione digitale delle aziende del SSN: tra investimenti del PNRR e spazi di autonomia manageriale,” in OASI Report 2024, pp. 469-491.

Read other articles in the OASI Report 2024 series:

Ricc and Longo - Tell me the truth about the Italian NHS: Four steps toward sustainable universality.

Broccolo, Guerra, Longo, & Zazzera - The digital revolution of general practitioners and their patients.

Bobini, Compagni, & Rotolo - Sustainability in healthcare: A new model for the future