IT Core and FSE: Italian FHIR profiles on a CDA document backbone
IT Core 0.2.0 is the HL7 Italy FHIR baseline. Fascicolo Sanitario Elettronico 2.0 still feeds CDA R2 documents. Telemedicine FHIR IGs are a parallel track. Codice fiscale uses http://hl7.it/sid/codiceFiscale.
Ala Ben Aicha
Direct answer
IT Core 0.2.0 is the HL7 Italy FHIR baseline. FSE 2.0 production still feeds CDA R2 documents. Telemedicine FHIR IGs exist. Codice fiscale uses http://hl7.it/sid/codiceFiscale.
FSE is not “Italy uses FHIR”
Fascicolo Sanitario Elettronico (FSE) is the national electronic health record. HL7 Italy’s realm page is blunt: HL7 CDA R2 standards are the ones formally adopted by national FSE, and the official document list lives on fascicolosanitario.gov.it. FHIR Implementation Guides are a parallel track: a national core, laboratory, the patient’s notebook (taccuino), and telemedicine services.
Do not write “Italy uses FHIR” in a tender unless you can name the package and version. For FSE document feeding, that name is still a CDA IG. For new structured APIs, it may be IT Core or a telemedicine IG.
| Layer | Owner / home | Canonical / package | What it is | What it is not |
|---|---|---|---|---|
| FSE 2.0 documents | Ministero della Salute / AgID / Sogei gateway; standard documentali | Normative CDA R2 IGs (PSS, LAB, LDO, VAC, RAD, RSA, VPS, …) listed by HL7 Italy as FSE-adopted | Production FSE content: CDA in a signed PDF wrapper, IHE XDS-style national/regional exchange | Not FHIR. Feeding FSE with a FHIR Bundle is not the current document contract |
| IT Core 0.2.0 (STU, 2026) | HL7 Italy; hl7.it/fhir/core | Official URL http://hl7.it/fhir/itcore/ImplementationGuide/hl7.fhir.it.core; package hl7.fhir.it.core#0.2.0 on FHIR R4 (generated 30 Jul 2026) |
Reusable Italian core profiles: PatientItCore, Practitioner, Organization, Coverage, Medication, Procedure | Not FSE onboarding, not a regional EHR |
| Telemedicine FHIR IGs | HL7 Italy + Agenas / DTD; realm list on hl7.it/realm-italiano | Televisita, Teleconsulto, Teleassistenza, Telemonitoraggio — each 0.2.0 STU on FHIR R4 (TelMon 2026) | FHIR specifications for the national telemedicine programme | Not the FSE document feed (CDA twins exist alongside) |
| Other FHIR IGs | HL7 Italy | Laboratory FHIR-LAB 0.2.0 STU; Taccuino FHIR-TAC 0.2.0 STU | Scoped FHIR documents / patient-entered content | Not a licence to skip CDA for FSE |
Primary sources: IT Core 0.2.0, HL7 Italy realm, FSE document standards. HL7 Italy states that only balloted STU/normative IGs are implementable in production; draft guides on the FHIR home page are informational.
The identifier: codice fiscale
Country-specific identifier on HL7 Italy Patient profiles is the codice fiscale, slice identifier:codiceFiscale:
http://hl7.it/sid/codiceFiscale
OID 2.16.840.1.113883.2.9.4.3.2. Sixteen alphanumeric characters (pat-id-cf-1). Do not publish a real codice fiscale. Keep the system URL and a dummy value in fixtures. STP / ENI codes are different identifier systems for people without a standard codice fiscale — they are not a free-text substitute on the codice fiscale slice.
Regional ids (idRegionale, ANPR) are additional slices in the Italian base Patient. They do not replace codice fiscale when the profile requires it.
What to implement first
- If the buyer is feeding FSE: the named CDA R2 IG from the FSE standard-documentali list, plus the regional/national gateway rules. FHIR Core is not that feed.
- If the buyer needs Italian FHIR Patient / practitioner / organisation: IT Core 0.2.0, codice fiscale system as above, package
hl7.fhir.it.core#0.2.0. - If the buyer is telemedicine (televisita, teleconsulto, teleassistenza, telemonitoraggio): the matching FHIR 0.2.0 IG, not FSE CDA and not a generic Encounter.
- For EHDS category 1, overlay EU Core. EU Core does not replace codice fiscale, and CDA PSS is not EEHRxF Patient Summary.
What this is not
This article is not FSE accreditation, not a Sogei gateway certificate, not Agenas telemedicine approval, and not legal advice. Implementing IT Core profiles does not authorise FSE publication. I do not operate regional FSE environments. Nothing here is clinical advice.
Related reading
For FSE document / FHIR hybrid architecture, use digital health interoperability or start a project.