The digitization of the healthcare sector is a powerful engine: it drives NHS towards more efficient, sustainable and participatory care models. E-health is, in fact, a generic term that indicates the use of information and communication technologies (ICT) to support the health system; it therefore includes a multiplicity of tools and actions. Among the tools of e-health, the Electronic Health Record (FSE) occupies a central place in the Italian legal system. The ESF is a consequence of the process of dematerialization of health documentation (a process started in Italy in 2011, involving medical records, prescriptions and reports). What are the advantages of this tool? What are the practical problems? How do Italy’s digital backwardness and regional fragmentation negatively affect its implementation?