5 questions to...
Natalia Pianesi
Interview with the Public Administration & Healthcare Director of Engineering.
Natalia Pianesi has been passionate about and involved in Public Administration and Healthcare for over 20 years, first with one of the top consulting firms and later with the Engineering Group.
In this context, she serves as Director of the Public Administration & Healthcare Consulting Division, the business consulting team specializing in digital transformation. She also leads the Healthcare Solution Consultants, the team of professionals responsible for implementing Engineering’s proprietary solutions for the healthcare sector.
In short, Natalia oversees the entire consulting services value chain – from strategic and organizational to application-level services – supporting our clients in redesigning, planning, and implementing the evolution and continuous improvement of their prevention, care, treatment, management, and governance processes, helping them generate increasing value through the power of digital technology.
1. THE NRRP HAS ALLOCATED SIGNIFICANT RESOURCES TO THE DIGITALIZATION OF HEALTHCARE. WHERE DO WE STAND WITH THE IMPLEMENTATION OF THESE PROJECTS, WHAT OBSTACLES REMAIN, AND HOW CAN WE OVERCOME THEM?
The NRRP is enabling the foundation of a critical layer of digitalization in healthcare processes, allowing our National Health System to recover from a clear lag in the international context and to decisively implement the "digital first" principle in every area of action.
This "digital building" effort is mainly being carried out in hospital care and remote care (telemedicine), while interventions in prevention and primary care have been more selective so far. In these areas, the NRRP has initially funded the “logistical” setup (e.g., the physical construction of Community Health Centers).
The key challenge has been - and remains - the balance between the content and quality of digitalization and the time available to implement it. The NRRP goals are undeniably ambitious in both content and deadlines, which are extremely challenging for deep "change management" interventions that aim to transform healthcare, prevention, and care processes through digital means.
At Engineering, we have approached - and continue to approach - NRRP projects with a distinctive “expert” and “agile” methodology, enabling us to support our clients in achieving these ambitious goals. “Expert,” because we apply the best practices developed with our many clients who have already adopted our solutions to support care and assistance processes - practices that were tested in real healthcare settings even before the NRRP, allowing us to avoid starting from a blank page for new initiatives. “Agile,” because we focus on incremental digitalization that reaches the core NRRP milestones within deadlines, while completing additional efforts sustainably over time.
In this scenario, it is worth highlighting that by establishing a vital digital baseline for the National Health System, the NRRP presents further digital transformation challenges. These are framed by the concepts of completing and elevating healthcare digitalization - goals we believe should be pursued with the same urgency and commitment that defined the NRRP era.
The completion of digitalization will mainly concern prevention and community-based medicine, where progress will depend on interoperability between systems in this domain and those used in hospitals and remote care. This will enable continuous tracking and optimization of citizens’ preventive-diagnostic-therapeutic-care pathways, truly activating the management of chronic conditions and health journeys - an impossible feat without digital tools.
The elevation of digitalization, instead, will involve further transformation of healthcare, prevention, and treatment processes using frontier technologies - especially those based on advanced data handling, such as AI.
2. INTEROPERABILITY REMAINS AN OPEN ISSUE. WHAT GOVERNANCE MODELS COULD IMPROVE COOPERATION BETWEEN INSTITUTIONS AT ALL LEVELS OF THE HEALTHCARE SYSTEM?
While interoperability certainly requires robust technological capabilities, its true driver is the semantics of processes and data. It is processes and their data that need to interoperate - before the IT applications that house or manage them.
From this perspective, applications across all levels of the healthcare system (intra-organization, inter-organization, between healthcare providers and Regions, between Regions, and between Regions and national health authorities) can only be truly interconnected if we identify and define how the processes and data from one system enable the operations of another - and vice versa. Only by focusing here can we bring interoperability techniques to life and unlock their full potential.
At Engineering, we have long adopted an approach to digital transformation that combines deep domain knowledge with technological mastery.
We increasingly apply this same approach to interoperability, where our proprietary solutions - technologically up to date - stand out not just for their features and technical standards, but also as standard models of cooperating processes and associated data exchanges. This model includes different levels of maturity, which we offer to healthcare organizations so they can choose the one that best matches their interoperability goals.
This approach also informs our system integration projects, where we help design and build diverse application ecosystems composed of legacy systems, new proprietary or third-party applications, and greenfield solutions. In these cases, focusing on the meaning of data and the needs of processes is both the starting point and the cornerstone for building functional systems that meet their intended business goals.
3. AI AND ADVANCED DATA ANALYSIS CAN HELP HEALTHCARE EVOLVE. WHAT REAL-WORLD APPLICATIONS ARE ALREADY IN USE, AND WHAT SHOULD WE EXPECT IN THE COMING MONTHS?
The NRRP-driven digitalization of the National Health System is finally laying the foundation for large-scale data assets that enable, on one hand, data analysis for governance and decision-making at all levels, and on the other, the effective integration of cutting-edge, data-centric technologies like AI. These technologies can only show their full value when working with extensive and historically rich data sets.
At Engineering, we support our healthcare clients in both completing their digital transformation - particularly through our proprietary clinical, healthcare, and care solutions - and elevating it through advanced data analytics.
We do this first through a portfolio of analytics solutions that provide essential insights into the processes managed by our proprietary applications (e.g., Electronic Medical Records, digital surgical pathways, telemedicine). These solutions are activated nimbly to provide operational insights and evolve as clients' needs become more sophisticated.
Second, we leverage our expertise in managerial accounting and performance control systems, which span all operational domains of healthcare organizations and map their economic impact. This gives leadership teams (locally, regionally, and nationally) an invaluable overview to drive performance improvement in healthcare - an effort that directly supports the sustainability of the entire system.
Third, we embed frontier technologies like AI into data analysis to complement traditional “retrospective” insights with predictive and simulation capabilities. This also transforms applications into data-driven tools.
Some recent examples of AI in action include:
In citizen engagement: conversational support throughout the CUP appointment booking lifecycle
In diagnostics: enabling pathologists to manage tasks remotely through digital pathology
In hospital treatment: supporting professionals in coding necessary for compiling hospital discharge records (SDOs)
In telemedicine: analyzing citizens' emotions during teleconsultations and remote assistance.
All of these are examples of AI actively transforming operational processes in healthcare organizations.
4. THE ELECTRONIC HEALTH RECORD (EHR) IS ESSENTIAL FOR CARE CONTINUITY AND EFFICIENCY. WHAT STEPS ARE NEEDED TO MAKE IT FULLY OPERATIONAL AND INTEGRATED ACROSS ALL REGIONS?
The most visible steps are those outlined by the Department for Digital Transformation for implementing EHR 2.0, involving the Regions and the IT industry working within the National Health System. This ongoing process aims to gradually increase the volume and variety of documents and data in the EHR. However, there are also crucial “behind the scenes” steps, equally important, that can boost this effort.
Foremost is the continuing digitalization of healthcare processes, largely driven by the NRRP, which lays the groundwork for the EHR to be populated not just by traditional diagnosis and treatment data but also from emerging fields like telemedicine, community-based care, chronic disease management, and prevention.
Next, we must consider the depth of change management required in healthcare organizations alongside the technological effort. This involves breaking deeply ingrained habits - for example, implementing report-signing procedures, aligning internal codes with reference standards, or increasing responsibility for validating documents - all of which are essential to feeding the EHR.
These changes go to the heart of clinical workflows and are necessary to ensure that content can be shared through the EHR. Without adequate focus on these steps, the transformative potential of the EHR is diminished.
Finally, there is a crucial need to avoid treating EHR implementation as just a compliance exercise focused on hitting numeric targets for uploaded documents.
In some cases, this perspective has overshadowed the real value the EHR offers for transforming healthcare processes. This mindset needs to be shifted so that the EHR is understood as a tool to enable a new, more effective way of delivering healthcare - something we at Engineering are already actively advocating and supporting.
5. HOW CAN WE ENSURE THE SUSTAINABILITY OF INNOVATION IN PUBLIC HEALTHCARE, BOTH ECONOMICALLY AND OPERATIONALLY?
By measuring and applying the golden rule of value, which should be the gold standard for proving that innovation - organizational and procedural first, technological second - is not a cost but an investment that improves the ratio between health outcomes (quality of care) and resources used (cost of care).
The ability to measure improvements in health outcomes and cost impacts of digitally driven innovation is no longer an insurmountable challenge.
Thanks to the digital foundations laid by the NRRP, we’ll soon have access to unprecedented data assets across the health system.
Now that data availability is no longer a barrier, we must tackle the next challenge - using this data to measure innovation’s impact on outcomes and costs. This is both a methodological and technological challenge. Once overcome, it will allow objective evaluations of innovation and drive its broader adoption.
At Engineering, we are committed to supporting our clients in meeting this challenge by designing performance measurement systems that are increasingly oriented toward generating value-based metrics.
At Engineering, we have approached - and continue to approach - NRRP projects with a distinctive “expert” and “agile” methodology, enabling us to support our clients in achieving these ambitious goals.
Natalia Pianesi
Public Administration & Healthcare Director, Engineering
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