10.14639/0392-100X-N2727
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1827-675X
2727
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Francesco Bussu
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ACTA Otorhinolaryngologica Italica
quality improvement
Opportunities and obstacles of electronic health records in Italy: towards enhanced surgical care  
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Letters to the Editor-in-Chief
2024-04-22
2023-08-18
2024-04-23
2024-04-23
140-142
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Francesco Bussu
2024/04/22
10.14639/0392-100X-N2727
140
Department of Medicine Surgery and Pharmacy, Sassari University, Italy; Otolaryngology Division, Azienda Ospedaliera Universitaria di Sassari, Italy. Corrisponding author - fbussu@uniss.it 
1827-675X
quality improvement
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Opportunities and obstacles of electronic health records in Italy: towards enhanced surgical care  
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ACTA OTORHINOLARYNGOLOGICA ITALICA 2024;44:140-142; doi: 10.14639/0392-100X-N2727




Letter to the Editor


Opportunities and obstacles of electronic health
records in Italy: towards enhanced surgical care
Michaele Francesco Corbisiero1, Davide Rizzo2,3, Roberto Gallus4, Pierpaolo Loreti5, Lorenzo Bracciale5,
Francesco Bussu2,3
1
  University of Colorado, School of Medicine, Denver, USA; 2 Department of Medicine Surgery and Pharmacy, Sassari University,
Italy; 3 Otolaryngology Division, Azienda Ospedaliera Universitaria di Sassari, Italy; 4 Otolaryngology Division, Mater Olbia Hospital,
Olbia, Italy; 5 University of Rome Tor Vergata, Department of Electronic Engineering, Rome, Italy


KEY WORDS: E-Health, Electronic Health Record, Electronic Medical Record, quality of
care, quality improvement

The potential of Electronic Health Records (EHRs) to streamline patient care
and surgical procedures, improve interprofessional collaboration, and ulti-
mately optimise healthcare delivery is a topic that has increasingly dominated
recent international academic and clinical discussions 1-3. This letter aims to
shed light on the necessity of embracing this change, specifically focusing on
the Italian context and on Otolaryngology in particular. It will assess its poten-
tial benefits, present the challenges that have emerged in the Italian scenario,
and suggest ways to navigate these hurdles.

Electronic Health Records
An EHR is a digital version of a patient’s paper chart. EHRs are real-time, pa-
tient-centered records that make information available instantly and securely to
authorised users. While an EHR does contain the medical and treatment histories
of patients, an EHR system is built to go beyond standard clinical data collected in
a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs
                                                                                             Received: August 18, 2023
function as a critical nexus within healthcare systems, connecting diverse entities          Accepted: September 6, 2023
responsible for managing patient health needs. The digitisation of healthcare infor-
mation, including patient paper medical diaries, imaging, and other clinical data,           Correspondence
streamlines interprofessional collaboration and bolsters coordination efforts 2. By          Francesco Bussu
                                                                                             E-mail: fbussu@uniss.it
consolidating sources of patient information, EHR aims to facilitate more efficient
and secure exchange of patient data among healthcare providers 4.
                                                                                               How to cite this article: Corbisiero MF, Rizzo
                                                                                               D, Gallus R, et al. Opportunities and obsta-
General and specific advantages of EHRs                                                        cles of electronic health records in Italy: to-
                                                                                               wards enhanced surgical care. Acta Otorhi-
Research from around the globe supports the notion that EHRs can signifi-                      nolaryngol Ital 2024;44:140-142. https://doi.
cantly enhance the quality of care. Specifically focusing on other European na-                org/10.14639/0392-100X-N2727
tions with similar healthcare systems, the implementation of EHRs in French
                                                                                             © Società Italiana di Otorinolaringoiatria
hospitals demonstrated a significant positive correlation with improved patient              e Chirurgia Cervico-Facciale
records, shortened information delays, and enhanced pain and nutritional sta-
tus evaluations 5. Similarly, a study conducted in Italy found that physicians                              OPEN ACCESS
and nurses recognised the potential benefits of EHRs, despite some resistance                This is an open access article distributed in accordance with
                                                                                             the CC-BY-NC-ND (Creative Commons Attribution-Non-
to their use 6. Therefore, EHRs are more than mere digital versions of paper                 Commercial-NoDerivatives 4.0 International) license. The
records, with a clear potential impact in both clinical and scientific areas.                article can be used by giving appropriate credit and mentio-
                                                                                             ning the license, but only for non-commercial purposes and
At the clinical level, EHRs have the power to revolutionise healthcare delivery              only in the original version. For further information: https://
by making patient health information accessible, reliable, and efficient – which             creativecommons.org/licenses/by-nc-nd/4.0/deed.en




140
                                                                                     EHRs in Italy: challenges & prospects for improved surgical coordination




serves as a valuable tool for healthcare professionals 2,7.                      as Clinical Decision Support as required by the interna-
The benefits of EHRs extend to the management of drug                            tional standard ISO/HL7 10781 Electronic Health Record
prescriptions and clinical risk, as highlighted by a recent                      System Functional Model (EHR-S FM) Release 2 8.
study conducted in two private hospitals in Northern Italy 1.                    Such clinical advantages are specifically evident in Otolar-
The transition from paper-based drug charts to digital re-                       yngology (Tab. I). In particular, residents would have more
cords yielded marked improvements in the accuracy and                            time for core training, which can be fundamental in light
appropriateness of prescriptions, minimised transcription                        of the known issues of surgical training in Italy. Moreover,
errors, and curtailed the risk of medication errors. Also, the                   Otolaryngology as an eminently interdisciplinary surgical
easy intuitive access to a Patient Summary (usually a core                       branch, could clearly benefit more than others from the im-
element of EHRs) highlights immediately relevant data                            proved interprofessional collaboration fostered by the EHR.
such as immunisation, drug allergies, previous surgeries                         At the research level, the systematic use of EHR has the
or current drug therapies, as recorded by any authoritative                      clear potential of reliably acquiring a huge amount of da-
sources such as general practitioners and other hospitals, in                    ta. Such potential could be exponentially increased by the
every phase of the management of surgical cases. The dig-                        application of FAIR principles (data and metadata must
itisation process may also reduce nursing staff workload,                        be Findable, Accessible, Interoperable, and Reusable) to
which allows them to focus more on patient care, and opti-                       metadata inclusion and to data acquisition 9.
mise the management of drug inventories in hospital phar-
macies, which can also lead to cost savings and increased                        Barriers to the implementation of EHRs
efficiency 1. Moreover, moving the EHR towards a greater                         However, despite the promise held by EHRs, numerous
number of encoded documents with machine readable parts                          barriers stand in the way of their full-scale implementation
(e.g., Clinical Document Architecture) with respect to mere                      and use. These challenges are both technical and human-
digitalised documents (e.g., scanned papers) enables the                         centric, including resistance to change and lack of adequate
creation of more intelligent services within the EHR such                        training, especially in the Italian reality 6,10.


Table I. Impact of EHRs on otolaryngological care.
 Aspect of care                                              Without integrated EHRs                                    With integrated EHRs
 Record keeping                                   Time-consuming manual entries, physical storage,      Rapid, accurate digital records, easily stored, shared,
                                                               increased chance of error                                      and retrieved
 Interprofessional collaboration                     Inefficient communication between different           Streamlined sharing of patient data, less chance
                                                healthcare providers, potential for missed information,    of miscommunication. Clear specific benefit for
                                                 which is even more relevant in Otolaryngology as an       Otolaryngology more than other specialties from
                                                eminently interdisciplinary surgical branch with close       heightened collaboration fostered by the EHR
                                                interactions with a large number of surgical and non-
                                                                   surgical specialties
 Drug management                                  Paper-based drug charts can lead to transcription         Improved accuracy of prescriptions, minimised
                                                  errors, medication errors, and inefficient inventory        errors, and efficient inventory management
                                                                      management
 Patient safety                                     Risk of errors due to miscommunication or lost           Improved patient safety due to consolidated,
                                                                       information                                     accessible patient records
 Time management                                    Significant time spent on manual transcribing        Reduction in paperwork enables increased time for
                                                   of paperwork, less time for direct patient care –      patient care, learning, and essential clinical tasks
                                                                  especially for trainees
 Cost efficiency                                      Higher costs associated with paper records        Potential cost savings from improved efficiencies and
                                                             management and inefficiencies              reduction in errors or repeat procedures and imaging
 Surgical outcomes                               Potential risks due to lack of shared information and         Minimise unnecessary procedures, reduce
                                                           comprehensive patient information                  risks, and improve outcomes due to access
                                                                                                        comprehensive patient histories and interprofessional
                                                                                                                             communication
 Surgical training                              Time spent by residents in transcribing paper records More time spared for core training and learning the
                                                                                                                                 specialty
 Data collection for research                    Absence of a shared language and domain-specific            Easy creation and widespread use of shared
                                                 vocabularies, difficulty to impose shared ontologies     ontologies according to FAIR principles, for clinical
                                                            according to the FAIR principles            data collection and generation of high-level evidence




                                                                                                                                                          141
M.F. Corbisiero et al.




According to previous reports, these barriers include low          stop at embracing this shift within our own clinics and hos-
interoperability of healthcare system infrastructures, the         pitals; it extends to actively advocating for the widespread
absence of a shared language and domain-specific vocabu-           adoption of EHRs across the entire Italian healthcare sector.
laries for clinical communication (a common ontology
which should follow the above mentioned FAIR principles)           Acknowledgements
among diverse healthcare providers, and absence of models          Special thanks to Professor Bussu for his vision, mentor-
for administrative process management 10.                          ship, and commitment to optimal patient care.
In addition, the Italian case also involves the federation of 21
different regional systems whose interoperability is expected      Conflict of interest statement
to be implemented by the Integrating the Healthcare Enter-         The authors declare no conflict of interest.
prise Information Technology Infrastructure technical speci-
fications and has a long history of privacy issues that in some    Funding
cases have slowed the creation, feeding and deployment of the      This research did not receive any specific grant from funding
Italian EHR. For example, only since May 2020 has it been          agencies in the public, commercial, or not-for-profit sectors.
possible to remove the consent for the creation and feeding
of the European Social Fund (Article 11 of Decree-Law No.          Author contributions
34 of May 19, 2020), while in August 2022 the negative opin-       MFC: conceptualisation, writing - original draft; DR: writ-
                                                                   ing - original draft; RG: writing - review & editing; PL:
ion of the guarantor temporarily halted the development of
                                                                   writing - review & editing, visualisation; LB: writing - re-
the new database called Ecosistema Dati Sanitari in use in the
                                                                   view & editing, visualisation; FB: conceptualisation, writ-
Italian EHR 2.0 (Fascicolo Sanitario Elettronico Italiano 2.0).
                                                                   ing - original draft, supervision, project administration.
These barriers, among others, hinder the wide-scale adop-
tion of EHRs and their resultant benefits. Moving forward,
                                                                   Ethical consideration
overcoming these obstacles would necessitate concerted
                                                                   Not applicable.
efforts from both policymakers and healthcare providers.
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