Background Implementation of Electronic Health Records (EHRs)—termed Fascicolo Sanitario Elettronico (FSE) in Italy—is a strategic priority within the National Recovery and Resilience Plan (PNRR), which allocates investments under Mission 6 (Health) to healthcare digitalisation. Despite national commitment, adoption of the FSE shows significant regional disparities. Data from the Fondazione GIMBE (July 2025), based on the Dipartimento per la Trasformazione Digitale monitoring dashboard updated to 31 March 2025, show that only 21% of citizens nationally consulted their FSE within a 90-day window, with citizen consent for data sharing ranging from 1% in several Southern regions (Abruzzo, Calabria, Campania) to 92% in Emilia-Romagna. Among medical specialists, FSE enablement rates in Calabria (26%) and Liguria (16%) remain far below the national average of 72%. The Osservatorio Sanità Digitale (2025) reports that digital health spending in Italy reached €2.47 billion in 2024, yet 55% of healthcare facilities identify resource constraints as the most significant barrier to digital innovation, with workforce competency gaps (40%) and insufficient digital culture (34%) as additional critical obstacles. This digital divide reflects interconnected barriers spanning infrastructure, governance, workforce capacity, and quality standardisation. Understanding these barriers and their policy implications is essential to achieve equitable healthcare digitalisation and to meet PNRR targets by mid-2026. Policy and Implications Four primary barriers were identified: (1) infrastructural deficits—documented digital divides between Northern and Southern Italy, with the SVIMEZ 2023 Report and the Osservatorio Sanità Digitale confirming persistent resource and connectivity gaps disproportionately concentrated in Southern and insular regions; (2) governance fragmentation—characterised by the absence of dedicated digital health units and senior information technology leadership in most Southern regions; (3) workforce capability gaps—with only 36% of medical specialists and 52% of general practitioners having used telemedicine services by 2025, and substantial training gaps in health informatics; and (4) insufficient integration of quality management and information security standards within procurement specifications. Recommendations A four-pillar policy strategy is proposed: (1) establish dedicated Regional Digital Health Units with autonomous governance, protected multiyear budgets, and measurable performance indicators; (2) integrate mandatory health informatics education into Continuing Medical Education (ECM) programmes, targeting ≥80% workforce digital competency by 2028; (3) require SNOMED CT/HL7 FHIR interoperability and ISO 9001/ISO IEC 27001 certification as mandatory procurement criteria; and (4) establish formal twinning arrangements between digitally mature Northern regions and developing Southern regions. Conclusions Bridging the North–South digital divide requires coordinated policy reform addressing governance, professional development, technical standardisation, and inter-regional collaboration. International evidence from Estonia and Denmark demonstrates that centralised governance, mandatory interoperability standards, and opt-out consent models accelerate nationwide EHR adoption. This evidence-informed strategy is operationally feasible within PNRR timelines and will strengthen the quality governance of health information systems across Southern Italian healthcare.
Fumai et al. (Mon,) studied this question.