From today, 31 March 2026, the Electronic Health Record (EHR) becomes active in all Italian regions. All healthcare facilities, public and private, are obliged to feed each citizen’s digital file according to common technical standards. The reports must be uploaded within five days of providing the service.
The declared objective is to reach full capacity by June 2026, definitively transforming the ESF from an experimental tool to a central infrastructure of the National Health Service.
What is the Electronic Health Record
The ESF is, in the words of the Ministry of Health:
the access point to digital health and social-health data and documents generated by clinical events concerning the patient.
Essentially, it collects a patient’s entire medical history: laboratory and radiology reports, discharge letters and emergency room reports. It also includes specialty and pharmacy prescriptions, medical records, vaccination data, screening exemptions and invitations, as well as other health documents.
The system was established in 2012 and was progressively activated in the regions starting from 2015, with an initially slow and uneven diffusion. The ESF 2.0 reform, supported by the European funds of the Pnrr, now aims to fill this delay and make the file a truly integrated tool that can be used throughout Italy.
What changes from March 31st
March 31, 2026 marks the completion of the third and final phase of the ministerial timetable. The main innovations concern:
- the obligation also extended to private structures, which must adapt to the technical standards of the ESF 2.0 and have a digital signature;
- after each visit, examination or administration of drugs, the data must be uploaded to the file within five days;
- the documents must be produced in a shared format, generally digitally signed PDFs, and transmitted to the regional portals, in the so-called Patient Summary (synthetic health profile);
- general practitioners and paediatricians of free choice must complete and update the summary health profile of each patient,
- regional digital infrastructures must comply with the interoperability and accessibility standards envisaged by the ESF 2.0.
For citizens, access is simple: simply use SPID, electronic identity card or health card with CNS functions to consult your clinical documents online. Consent to consultation by healthcare professionals can be modified or revoked at any time, without any consequence on the healthcare services to which you are entitled.
But the gaps between the Regions remain
By today, all systems will have to adapt to the standards of the Electronic Health Record 2.0, in terms of technical requirements, interoperability and accessibility for structures, healthcare professionals and citizens. Despite the progress, the most recent data from the Ministry of Health (between July and September 2025) still highlight significant territorial differences. Among family doctors and paediatricians of free choice, 95.2% carried out at least one operation on the system in the last quarter, but with variations ranging from 86.9% in Friuli Venezia Giulia to 99.9% in Emilia-Romagna.
Finally, citizen participation is critical. In July, only 27% had used the file in the previous three months, with a peak of 66% in Veneto and minimum values (3%) in Basilicata, Marche, Puglia and Sicily.
| Region | Percentage of ESF use |
|---|---|
| Abruzzo | 7% |
| Basilicata | 3% |
| Calabria | 6% |
| Campania | 29% |
| Emilia-Romagna | 64% |
| Friuli Venezia Giulia | 20% |
| Lazio | 7% |
| Liguria | 7% |
| Lombardy | 53% |
| Marche | 3% |
| Molise | 4% |
| PA Bolzano | 20% |
| PA Trento | 46% |
| Piedmont | 20% |
| Puglia | 3% |
| Sardinia | 10% |
| Sicily | 3% |
| Tuscany | 40% |
| Umbria | 7% |
| Aosta Valley | 24% |
| Veneto | 66% |
Even in terms of available services, the picture remains incomplete. No Region yet offers the entire set of over 40 services and documents provided by the ESF, with very large differences between territories.
