# 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. Author: Ala Ben Aicha Canonical page: https://alabenaicha.me/insights/fhir-it-fse-hl7-italy Updated: 2026-09-19 ## 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 . ## 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](https://www.fascicolosanitario.gov.it/portale/standard-documentali). 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](https://www.fascicolosanitario.gov.it/portale/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](https://www.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](https://www.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](https://www.hl7.it/fhir/core), [HL7 Italy realm](https://www.hl7.it/realm-italiano/), [FSE document standards](https://www.fascicolosanitario.gov.it/portale/standard-documentali). 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 1. 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. 2. 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`. 3. If the buyer is **telemedicine** (televisita, teleconsulto, teleassistenza, telemonitoraggio): the matching FHIR 0.2.0 IG, not FSE CDA and not a generic Encounter. 4. For EHDS category 1, overlay [EU Core](https://alabenaicha.me/insights/fhir-eu-core-ehds-implementation). 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 * [FHIR implementation guides by country](https://alabenaicha.me/insights/fhir-implementation-guides-by-country) * [EU Core and EHDS](https://alabenaicha.me/insights/fhir-eu-core-ehds-implementation) * [IHE profiles in European healthcare](https://alabenaicha.me/insights/ihe-profiles-european-healthcare-integration) For FSE document / FHIR hybrid architecture, use [digital health interoperability](https://alabenaicha.me/services/digital-health-interoperability) or [start a project](https://alabenaicha.me/contact?intent=project).