Italy’s National Healthcare System and eHealth Landscape

Background Italy has recently undertaken reforms and initiatives to strengthen the National Healthcare System (Servizio Sanitario Nazionale [SSN]). Part of these reforms is a major digital transformation, supported by funding from the National Recovery and Resilience Plan (Piano Nazionale Ripresa Resilienza [PNRR]) to strengthen electronic health (eHealth) capabilities. Whilst progress is being made, the decentralised nature of the SSN governance structure makes it challenging to ensure equitable implementation and widespread adoption of the digital transformation. Objective This documentary policy analysis looks at Italian strategic documents and performance data publicly available for health and eHealth, to assess the progress and divergence between legislative intent of the digital transformation and the operational reality, specifically regarding regional disparities and the digital divide. Methods Qualitative documentary policy analysis of a corpus of sources comprising national policy texts, national and European institutional monitoring reports and statistical datasets (Istituto Nazionale di Statistica [ISTAT], Agenzia Nazionale per i Servizi Sanitari Regionali [AGENAS] and Ministero della Salute) published between 2019 and 2025. A deductive thematic analysis was conducted to triangulate policy goals with successes and barriers to implementation. Findings The analysis reveals a lag between infrastructure investment and the widespread adoption of eHealth in Italy. There is a gap between the intention to use eHealth tools and their actual use amongst healthcare professionals, particularly for telemedicine during and shortly after the COVID‐19 pandemic. There are low adoption rates for eHealth amongst users, notably the electronic health record (FSE 2.0), with disparities between northern and southern regions. Conclusion State investments in digital infrastructure are necessary but not sufficient to ensure the adoption of eHealth amongst healthcare professionals and users. Simultaneous financial and digital literacy interventions will complement the digital reforms, encourage the widespread adoption of eHealth and reduce the risk of health inequalities and burnout amongst healthcare professionals.