InFSE, OpenInFSE, and OpenInFSE 2.0

The InFSE project has been carried out as part of a collaboration between the Department for Digitization of the Public Administration and Technological Innovation of the Presidency of the Council of Ministers and the National Research Council (CNR). It has been aimed at supporting the process of development of a federated Electronic Health Record (EHR) infrastructure of the citizen, shared at a national level and compliant to the international scene, with particular attention to the issues of security and privacy.

The purpose of InFSE has been the design of a technology infrastructure that can enable citizens and authorized health professionals to access health information of their competence, wherever they are located in the national territory and subject to the protection of privacy, and to facilitate the management of healthcare processes.

The OpenInFSE project has aimed to realize an Italian interoperability framework for EHR systems. This framework has made operational the InFSE infrastructure architectural model by implementing a set of software components and deploying them at the nodes of several Italian Regions.

Finally, the OpenInFSE 2.0 project has been a continuation of the previous initiatives, with the intention to consolidate the results already obtained and to support the spread on the territory of a solution for the technological interoperability of EHR systes, and open to the new paradigm of Cloud Computing.


Architectural model of InFSE


The projects have achieved the following objectives:
  • Analysis of the state of the art on the projects and initiatives related to EHR on a national basis.
  • Approval of the guidelines and specifications on the InFSE infrastructure by the Table of Electronic Health of the Italian Regions and Autonomous Provinces (TSE).
  • Development of an operational federated infrastructure to support the interoperability among territorial EHR solutions in the context of the Public System of Connectivity (SPC, a set of technological infrastructures for the cooperation among Italian Public Administrations).
  • Definition and implementation of interoperability technological solutions and software components shared among all the relevant actors.
  • Development of models for the integration of value-added services for the citizen, in line with the strategies of reorganization of the care processes aiming at providing an increasing role in home care.


Experimentations have been carried out to test the interoperability among the EHR systems of Calabria, Campania, and Piemonte Regions.
Moreover, the proposed infrastructure has been used by the Regions (Lombardia, Abruzzo, Emilia Romagna, Molise, Friuli Venezia Giulia, Sardegna, Toscana, Umbria, Veneto, and Autonomous Province of Trento) which have participated to the Italian IPSE project (linked to the European epSOS project) with the aim of making their regional EHR systems able to interoperate each other for the interchange of patient summaries.
Finally, another experimentation of the infrastructure has regarded the interchange of healthcare documents among the EHR systems of Calabia, Campaina, and Tuscan Regions.


M. Ciampi and M. Sicuranza, "Componenti OpenInFSE", software components developed as Web Services in compliance to the InFSE architectural model and technical specifications. Software can be downloaded here.

Selected publications

  • M. Sicuranza, A. Esposito, and M. Ciampi "A View-Based Access Control Model for EHR Systems", in IDC 2014: 8th International Symposium on Intelligent Distributed Computing, Madrid, Spain, Studies in Computational Intelligence, Volume 570, 2015, pp 443-452
  • M. Sicuranza, A. Esposito, M. Ciampi, "An access control model to minimize the data exchange in the information retrieval", Journal of Ambient Intelligence and Humanized Computing, Springer Berlin Heidelberg, 2015
  • M. Ciampi, M. Sicuranza, A. Esposito, G. De Pietro, "Progettazione e realizzazione di servizi per l’interoperabilità del Fascicolo Sanitario Elettronico mediante l’infrastruttura InFSE", Istituto di Calcolo e Reti ad Alte Prestazioni del Consiglio Nazionale delle Ricerche, sede di Napoli, Technical Report no. RT-ICAR-NA-2015-4, pp. 1-30, 2015, available at (Italian)
  • M. Sicuranza, A. Esposito, and M. Ciampi, "A Patient Privacy Centric Access Control Model for EHR Systems", International Journal for Internet Technology and Secured Transactions, vol. 5, pp. 163-189, 2014
  • G. De Pietro, M. Ciampi, "Interoperabilità del fascicolo sanitario elettronico: stato dell'arte ed evoluzione", Rivista elettronica di diritto, economia, management, vol. 3, pp. 61-73, ClioEdu, 2014 (Italian)
  • C. Esposito, M. Ciampi, and G. De Pietro, "An event-based notification approach for the delivery of patient medical information", Information Systems, Vol. 39, pp. 22-24, Elsevier, January 2014.
  • M. Ciampi, A. Esposito, M. Sicuranza, "Progettazione e realizzazione di un algoritmo per il controllo degli accessi basato sul modello MPP-ABAC", Istituto di Calcolo e Reti ad Alte Prestazioni del Consiglio Nazionale delle Ricerche, sede di Napoli, Technical Report no. RT-ICAR-NA-2014-01, pp. 1-15, 2014, available at (Italian)
  • M. Sicuranza and M. Ciampi, "A semantic access control for easy management of the privacy for EHR systems", in CADSA 2014: 2nd International Workshop on Cloud and Distributed System Applications, Guangzhou, China, November 8-10, 2014.
  • M. Ciampi, "Strategie di system integration per l'interoperabilità di sistemi eterogenei di Fascicolo Sanitario Elettronico", Istituto di Calcolo e Reti ad Alte Prestazioni del Consiglio Nazionale delle Ricerche, sede di Napoli, Technical Report no. RT-ICAR-NA-2014-02, pp. 1-24, 2014, available at (Italian)
  • M. Ciampi, G. De Pietro, C. Esposito, M. Sicuranza, and P. Donzelli, "A Federated Interoperability Architecture for Health Information Systems", International Journal of Internet Protocol Technology, Inderscience Publishers, vol. 7, no. 4, pp. 189-202, 2013
  • M.C. Buzzi, E. Cesario, M. Ciampi, G. De Pietro, F. Folino, P. Mori, M. Sicuranza, P. Storniolo, D. Talia, A. Urso, "Linee guida per il Cloud In Sanità: Modelli, servizi e infrastruttura per il Fascicolo Sanitario Elettronico", CNR – SeGID, Collana Documentalia, Vol. 4, 2013, ISBN: 978-88-906334-3-0, ISSN: 2239-8414 (Italian).
  • M. Sicuranza, M. Ciampi, G. De Pietro, and C. Esposito, “Secure Healthcare Data Sharing among Federated Health Information Systems”, to be printed in the International Journal of Critical Computer-Based Systems, Inderscience Publishers, 2013
  • A. Esposito, M. Sicuranza, M. Ciampi, "A Patient Centric Approach for Modeling Access Control in EHR Systems", in ICA3PP 2013: Proceedings of the 13th International Conference on Algorithms and Architectures for Parallel Processing, Lecture Notes in Computer Science, Volume 8286, 2013, pp 225-232, DOI: 10.1007/978-3-319-03889-6_26
  • L. Coppolino, S. D’Antonio, L. Romano, G. De Pietro e M. Ciampi, “Monitoraggio della sicurezza di infrastrutture critiche sanitarie: il caso di studio del Fascicolo Sanitario Elettronico”, Telemedicina ed Informatica Medica: Le nuove tecnologie per la salute, pp. 57-67, CNR – SeGID, Collana Documentalia, 2013 (Italian)
  • M. Ciampi e M. Sicuranza, “L’infrastruttura InFSE a supporto del modello funzionale HL7 EHR-S”, Telemedicina ed Informatica Medica: Le nuove tecnologie per la salute, pp. 43-56, CNR – SeGID, Collana Documentalia, 2013 (Italian)
  • M. Ciampi, G. De Pietro, C. Esposito, M. Sicuranza, P. Mori, A. Gebrehiwot, and P. Donzelli, "On Securing Communications among Federated Health Information Systems", in SAFECOMP 2012 Workshops: Proceedings of the 31st International Conference on Computer Safety, Reliability and Security, Lecture Notes in Computer Science, vol. 7613, pp. 235-246, 2012, Springer-Verlag Berlin Heidelberg
  • M. Ciampi, G. De Pietro, C. Esposito, M. Sicuranza, and P. Donzelli, “On Federating Health Information Systems”, in GUT 2012: Proceedings of the International Conference in Green and Ubiquitous Technology, pp. 139-143, 2012, IEEE Press
  • C. Esposito, M. Ciampi, G. De Pietro, and P. Donzelli, “Notifying Medical Data in Health Information Systems”, in DEBS 2012: Proceedings of the 6th ACM International Conference on Distributed Event-Based Systems, pp. 373-374, 2012, ACM New York, NY, USA, ISBN: 978-1-4503-1315-5, DOI: 10.1145/2335484.233552
  • G. De Pietro, A. Coronato, M. Ciampi, A. M. Urso, M. Cossentino, R. Rizzo, P. Storniolo, F. Folino, M. C. Buzzi, A. Gebrehiwot, “L’infrastruttura tecnologica del Fascicolo Sanitario Elettronico”, I. Florio, M. T. Guaglianone (Eds.), Il Fascicolo Sanitario Elettronico: Infrastruttura tecnologica e codifica dei dati, pp. 85-127, 2012, CNR – SeGID, Collana Documentalia, ISBN: 978-88-906334-1-6, ISSN: 2239-8414 (Italian)
  • G. De Pietro, R. Guarasci, M. Ciampi, A. M. Urso, M.C. Buzzi, C. Pizzuti, “L’interoperabilità nazionale del Fascicolo Sanitario Elettronico: il progetto InFSE”, P. Tarallo (Ed.), Verso e-Health 2020, Il Sole 24 Ore Sanità, 2012, ISBN: 978-88-324-8172-3 (Italian)
  • M. Ciampi, “The Metadata Information Model for the Italian Interoperability Infrastructure for EHR Systems”, Istituto di Calcolo e Reti ad Alte Prestazioni del Consiglio Nazionale delle Ricerche, Napoli branch, Technical Report no. RT-ICAR-NA-12-02, pp. 1-15, 2012, available at
  • P. Donzelli, G. De Pietro, R. Guarasci, M. Ciampi, and M. T. Chiaravalloti, "Infrastruttura del Fascicolo Sanitario Elettronico: dalle regole alla realizzazione", e-HealthCare: Innovazione e Tecnologie in Sanità, Anno 4, Numero 20, Settembre – Ottobre 2012, pp. 16-22, Edisef, ISSN: 2038-4238 (Italian)
  • G. De Pietro e M. Ciampi, “L’interoperabilità del FSE: il progetto OpenInFSE”, e-Health Care: Innovazione e Tecnologie in Sanità, Anno 3, Numero 13, Luglio – Agosto 2011, pp. 8-14, Edisef, ISSN: 2038-4238. Protagonisti del mese (Italian)