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HEALTH

OPINION: Italian healthcare is stuck in the past – but now it has a chance to modernise

The move to digital prescriptions was one positive to come out of the pandemic in Italy, but this could soon be reversed - despite the urgent need for more reform, says Silvia Marchetti.

OPINION: Italian healthcare is stuck in the past - but now it has a chance to modernise
Paper prescriptions were the only option in Italy until the Covid pandemic. (Photo by Tiziana FABI / AFP)

At the end of 2022, Italy’s government approved a one-year extension of electronic prescription for medicines, but it is just temporary and there’s a high risk it might disappear in 2024.

The e-prescription should be made a permanent measure, alongside other urgent improvements in the Italian healthcare system that’s in need of modernization.

In recent weeks, doctors and patients held their breath as political parties debated the fate of digital prescription slips. Until the very end, it looked like the digital ricetta medica was going to be shelved, reverting in January to the pre-Covid paper slips and the nuisance of going to the doctor to fetch it.

The e-prescription has been one of the few positive outcomes of the pandemic. It proved a godsend for both general practitioners (medici di base) and patients during the Covid emergency, when social distancing was the norm and crowding at the doctor’s office was the best way to pass on bacteria and viruses.

Many Italians turned to the digital ricetta during lockdown, even those who’d normally queue up regularly at the doctor’s just to grab their prescription and go to the pharmacy.

READ ALSO: Five essential facts about Italy’s public healthcare system  

The ricetta elettronica also spares a lot of paper waste and precious time, allowing people to go shopping or to the gym instead of waiting hours in line. It has helped to boost the digitalization of Italian health care.

Before Covid, even patients with chronic diseases who needed a monthly prescription had to knock at their doctors’ door.

If next year there is no radical reform that makes digital ricetta the rule and a structural measure, it would be a major step back. 

Photo by Marco BERTORELLO / AFP

The truth is that not all doctors, nor patients (particularly the elderly), are digital savvy. Many doctors I know still prefer to write by hand the paper prescriptions with their personal signature.

My medico di base really needs to retire. He is 70 and even though patients call him by phone to order prescriptions he is able to send just some ones via email while others for specific medicines they still have to pick up at his office, getting in line as if they had to be visited. It is a major nuisance.

When I was living in Holland back in 2005 doctors were accustomed to sending digital prescriptions straight to the pharmacy nearest to the patient’s home, who just had to stop by after work. 

Patients with chronic diseases would regularly drop by the pharmacy next door and pick up the monthly prescribed dose. I wish it worked the same way in Italy.

READ ALSO: How bad is Italy’s north-south ‘healthcare gap’ really?

There are many other aspects of healthcare that should be modernised permanently in Italy. 

And this can be done by boosting online centralized services, which citizens could have access to through their fascicolo elettronico sanitario (electronic medical file), which is like their ‘health passport’ where all health information should be stored, from prescribed medicines to allergies, hospitalizations and results of exams. 

The fascicolo was launched with Covid to download test results and green passes, but it has enormous potential. It is linked to a personal tessera sanitaria (the health card), otherwise known also as the codice fiscale (tax identification number).

The electronic fascicolo should allow the booking of medical appointments and exams at public and private hospitals, and the ordering of medicines at your pharmacy that do not need a prescription. An SMS could be sent to alert patients when medicines and exam results are ready.

Much-needed healthcare improvements also include more efficient online bookings of doctors’ appointments, check-ups and exams. Many hospitals and clinics have online platforms for private booking, but these seldom work well due to internet glitches so patients have to revert to call centers which are always busy, leave their number and hope to be called back. Online platforms are also useful if one has to cancel an appointment.

READ ALSO: Who can register for national healthcare in Italy?

There should be online tickets for blood tests at medical labs and hospitals, downloadable on smartphones with a precise time. It’s crazy that people need to queue up early in the morning, without breakfast, just to take the bigliettino (ticket with their number) and wait to be called by the nurse for the blood test.

In Italy everyone knows that national healthcare waiting lists for surgeries, exams and day procedures can be months-long, but private facilities, where patients are willing and can afford to pay, cannot be as slow as the public sector. I remember once having to book an emergency private allergy test by phone and finding out I had to wait four months, despite it being at one of the biggest hospitals in Rome. 

Private appointments at public hospitals, which can cost up to €300, need to implement faster appointment procedures and boost the number of available doctors.

Italian public healthcare is one of the most democratic in the world, willing to treat anyone in need for free. But when it comes to modernisation, there are many challenges yet to overcome.

Member comments

  1. My doctor does use electronic prescriptions sent to the pharmacy, but then I need to go to the pharmacy to show my copy so they can order. the medication as the government does not allow them to keep a stock. Admittedly it’s not a standard medication but you would think the pharmacy could place the order without my confirmation .

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EES PASSPORT CHECKS

How will the new app for Europe’s EES border system work?

With Europe set to introduce its new Entry/Exit biometric border system (EES) in the autumn there has been much talk about the importance of a new app designed to help avoid delays. But how will it work and when will it be ready?

How will the new app for Europe's EES border system work?

When it comes into force the EU’s new digital border system known as EES will register the millions of annual entries and exits of non-EU citizens travelling to the EU/Schengen area, which will cover 29 European countries.

Under the EU Entry/Exit System (EES), non-EU residents who do not require a visa will have to register their biometric data in a database that will also capture each time they cross an external Schengen border.

Passports will no longer be manually stamped, but will be scanned. However, biometric data such as fingerprints and facial images will have to be registered in front of a guard when the non-EU traveller first crosses in to the EU/Schengen area.

Naturally there are concerns the extra time needed for this initial registration will cause long queues and tailbacks at the border.

To help alleviate those likely queues and prevent the subsequent frustration felt by travellers the EU is developing a new smartphone app.

READ ALSO: What will the EES passport system mean for foreigners living in Europe?

The importance of having a working app was summed up by Uku Särekanno, Deputy Executive Director of the EU border agency Frontex in a recent interview.

“Initially, the challenge with the EES will come down to the fact that travellers arriving in Europe will have to have their biographic and biometric data registered in the system – border guards will have to register four of their fingerprints and their facial image. This process will take time, and every second really matters at border crossing points – nobody wants to be stuck in a lengthy queue after a long trip.”

But there is confusion around what the app will actually be able to do, if it will help avoid delays and importantly when will it be available?

So here’s what we know so far.

Who is developing the app?

The EU border agency Frontex is currently developing the app. More precisely, Frontex is developing the back-end part of the app, which will be made available to Schengen countries.

“Frontex is currently developing a prototype of an app that will help speed up this process and allow travellers to share some of the information in advance. This is something we are working on to support the member states, although there is no legal requirement for us to do so,” Uku Särekanno said in the interview.

Will the 29 EES countries be forced to use the app?

No, it is understood that Frontex will make the app available on a voluntary basis. Each government will then decide if, when and where to use it, and develop the front-end part based on its own needs.

This point emerged at a meeting of the House of Commons European scrutiny committee, which is carrying out an inquiry on how EES will impact the UK.

What data will be registered via the app?

The Local asked the European Commission about this. A spokesperson however, said the Commission was not “in a position to disclose further information at this stage” but that travellers’ personal data “will be processed in compliance with the high data security and data protection standards set by EU legislation.”

According to the blog by Matthias Monroy, editor of the German civil rights journal Bürgerrechte & Polizei/CILIP the Frontex app will collect passengers’ name, date of birth, passport number, planned destination and length of stay, reason for travelling, the amount of cash they carry, the availability of a credit card and of a travel health insurance. The app could also allow to take facial images. It will then generate a QR code that travellers can present at border control.

This, however, does not change the fact that fingerprints and facial images will have to be registered in front of a guard at the first crossing into the Schengen area.

So given the need to register finger prints and facial images with a border guard, the question is how and if the app will help avoid those border queues?

When is the app going to be available?

The answer to perhaps the most important question is still unclear.

The Commissions spokesperson told The Local that the app “will be made available for Schengen countries as from the Entry/Exit System start of operations.” The planned launch date is currently October 6th, but there have been several delays in the past and may be another one.

The UK parliamentary committee heard that the prototype of the app should have been ready for EU member states in spring. Guy Opperman, Under-Secretary of State at the UK Department for Transport, said the app will not be available for testing until August “at best” and that the app will not be ready in time for October. The committee previously stated that the app might even be delayed until summer 2025.

Frontex’s Särekanno said in his interview: “Our aim is to have it ready by the end of the summer, so it can then be gradually integrated into national systems starting from early autumn”.

READ ALSO: How do the EES passport checks affect the 90-day rule?

Can the system be launched if the app is not ready?

Yes. The European Commission told The Local that “the availability of the mobile application is not a condition for the Entry/Exit System entry into operation or functioning of the system. The app is only a tool for pre-registration of certain types of data and the system can operate without this pre-registration.”

In addition, “the integration of this app at national level is to be decided by each Schengen country on a voluntary basis – as there is no legal obligation to make use of the app.”

And the UK’s transport under secretary Guy Opperman sounded a note of caution saying the app “is not going to be a panacea to fix all problems”.

When the app will be in use, will it be mandatory for travellers?

There is no indication that the app will become mandatory for those non-EU travellers who need to register for EES. But there will probably be advantages in using it, such as getting access to faster lanes.

As a reminder, non-EU citizens who are resident in the EU are excluded from the EES, as are those with dual nationality for a country using EES. Irish nationals are also exempt even though Ireland will not be using EES because it is not in the Schengen area.

Has the app been tested anywhere yet?

Frontex says the prototype of the app will be tested at Stockholm’s Arlanda Airport, in Sweden. Matthias Monroy’s website said it was tested last year at Munich Airport in Germany, as well as in Bulgaria and Gibraltar.

According to the German Federal Police, the blog reports, passengers were satisfied and felt “prepared for border control”.

This article is published in cooperation with Europe Street News.

 
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