Territorial Operative Center (COT): the future of the Italian healthcare system

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Italy aims to reform the national healthcare system by implementing a territorial care model that brings people and their care and prevention needs closer to healthcare facilities and operators. How? Thanks to the funds allocated by the NRRP, which, once the pandemic emergency is over, aims to rationalize and streamline the national health care system.

To this end, a reform of the organizational model of the territorial care network based on:

  • enhancing home care, including through the use of telemedicine;
  • the construction of new health facilities and care centers on the territory that improves accessibility and expands the availability of proximity services to citizens;
  • the definition of a new public plan for improving prevention nationally.

What is the COT (Territorial Operative Center)

The COT (Territorial Operations Center) is defined as a territorial organizational model that aims to ensure continuity, accessibility, and integration of care and assistance.

This new entity will have to develop a digital and data-driven strategy on the various hospital discharge pathways and identify the most appropriate care pathways concerning the citizen’s clinical and social profile. Operators involved in COT will also develop skills related to the use of telemedicine platforms – telemonitoring and teleassistance – promoting prevention and health education paths.

COT will have multiple responsibilities, mainly to be the point of contact between the different phases of the patient journey, whether chronic or acute. The areas of action are defined below:

  • Hospital-territory continuity of care;
  • Home care and palliative care;
  • Chronicity/Fragility and Residency;
  • Family and Community Nurse Care;
  • Pharmaceutical Care and Prosthetic Supply;
  • Legal Medicine, Disability, and Transportation.

The role of NRRP to empower digital transformation

Enabling the creation of territorial monitoring structures relying on digital technologies is a path that is obliged by the ‘One health’ approach aimed at innovating and optimizing the provision of care and assistance services. The NRRP control room, along with Agenas and Consip, will have the mission of allocating the funding in the best possible way, avoiding the need for an autonomous and fragmented approach but defining a common digital transformation strategy. 

Precisely because of this need for innovation, also tied with a collective responsibility to improve the quality of the care provided, the NRRP funds will allow the development of at least 600 COT to take on citizens’ requests and link them with available services and professionals, ensuring continuity, accessibility, and integration of health and social-health care.

The resources available for this challenging project are EUR 280 million, distributed as follows:

  • ~ EUR 103 million for the COT digital architectures implementation;
  • ~ EUR 42 million for corporate interconnection;
  • ~ EUR 58 million to devices supporting operators and patients;
  • 50 million to implement a pilot project for artificial intelligence services to support primary care;
  • ~ EUR 25 million for the Enhancement of the Transparency Portal.

Why COT is important for the citizens and the Italian healthcare system

Strengthening proximity care and identifying the patient’s home as the first place to receive care are the strategies to deliver timely, effective, and preventive health services.

The creation of territorial operations centers will make it possible, thanks to state-of-the-art technology, to have a control and monitoring tower of locally active services, but even more importantly, it will ensure that patients are taken care of in the most appropriate place, providing a clear view of the person’s clinical history, regardless of previous care touchpoints.

Finally, making clinical documentation and treatment pathways interoperable will significantly raise the quality and efficiency of the work of healthcare professionals, who will feel more autonomous and confident in delivering care and assistance services. In particular, the COT pursues five main objectives: 

  • Coordination of the person’s care;
  • Optimization of the care network;
  • Tracking and monitoring the transition between moments of care;
  • Information and logistical support to general practitioners;
  • Collection and monitoring of integrated chronicity pathways of patients in home care.

The COT’s Target cloud-native Architecture

The implementation of the IT infrastructure supporting the COT will have to, at a logical-functional level, make the following tools available to the operators:

  • updated mapping of all services in the territorial and hospital network with all the necessary information;
  • access to functionality to intake records providing information on which health services are active;
  • dashboard for managing and monitoring care setting transitions with information on their status and characteristics;
  • system for receiving and sending notifications integrated with the transitions dashboard. 

The target architecture is characterized by an event-driven approach aimed at maximizing interoperability between the different stakeholders and systems. In fact, from the image below you can see that the HL7 FHIR standard enables the creation of a communication and data integration layer for the exchange of information between healthcare facilities and COT. Therefore, it will be necessary to create a robust, scalable, and performance-efficient IT architecture ready to exchange data with departmental and hospital information systems, feeding and receiving information from the Event Broker from the underlying business and legacy systems. 

Source: Quaderno di Monitor “La Centrale Operativa Territoriale: dalla realizzazione all’attivazione” – Published by AGENAS, 2022.

The use of cloud-native technologies for the development of new applications and digital architectures is not only a fundamental prerogative for building the concept of ‘territorial proximity’ since it enables the interoperability of healthcare data but also makes it possible to build solutions that are sustainable over time and easy to scale up.


Where patients have ensured the most appropriate care depending on their pathology and territory of reference, the Italian healthcare system is guaranteed sustainability on several fronts, from the purely economic one to the need to ensure equity of access to care over the years. 

Mia-Care is currently helping some institutional stakeholders to address the creation of event-driven architectures dedicated to creating COT that is not only centers of territorial care but also holders and guarantors of clinical data shared by patients.

The article was written by Andrea Di Carlo, .

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