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Objectives: The purpose of this paper is to present and discuss the adoption and use of medical terminologies and coding systems in Italy, focusing on their management and integration for guaranteeing semantic interoperabil- ity among Electronic Health Records (EHRs). Semantic interoperability guarantees meaningful exchange of data between two or more healthcare information systems, en- suring that data content is not only understandable within its original context, but also in the destination one, and is capable of supporting health service management, clinical decision-making care collaboration, as well as public health reporting, and improving clinical research. Methods: The approach used for the coding systems man- agement and integration in the Italian Fascicolo Sanitario Elettronico (FSE)a use case is presented according to the current Italian regulations on federated EHRs. Results: Results show the need to promote an advanced approach, in conformance to the literature best cases, which takes care about a better integration and mainte- nance of medical terminologies and coding systems through the use of standardized models of terminology services. Conclusion: The paper presents terminology interoper- ability issues arisen from the described approach and re- lated requirements to propose a solution that could allow, through sophisticated terminology services framework, to achieve also in Italy semantic interoperability.

Healthcare Terminology Management and Integration in Italy: Where we are and What we need for Semantic Interoperability