# Ensuring the Long-Term Preservation of and Access to the Italian Federated Electronic Health Record
## 3 Materials and Methods
### Enhanced Use of Metadata Schema for FSE Document Long-Term Preservation and Access  
In this subsection, a conceptual and methodological description of the enhanced use of metadata to support the FSE long-term preservation process is presented, by highlighting its interaction with the FSE document management phase, since the two moments cannot be subordinated to each other. Regarding this, [PERSON] et al. state that \"digital preservation needs to be ongoing with activities integrated into all phases of creating, managing, and storing information\" and \"digital objects are inherently more vulnerable than analog materials and require immediate attention from the point of creation\" [34]. Currently, each clinical document indexed in the FSE is furnished with a set of metadata, both mandatory and optional, as required by the aforementioned Guidelines (e.g., IdDoc, Document Type, Object, Role, FormatID, DocVersion, Preservation Time, etc.). In this context, metadata plays a fundamental role as it can give evidence of the link between the duplicated document indexed in the FSE and its original preserved by the healthcare facility who produced it. Because of this, the original document needs to be persistent thus guaranteeing its visibility and accessibility, as well as its probative value, over the FSE active period (and for a certain number of years after the patient's death). This means it cannot undergo the conventional discard policies established by the health facility's long-term preservation service, but it needs to be in some way connected to the FSE validity. The information about the document indexing in the FSE registry is reported through a specific indexing metadata provided by the AD Italy [11], which is the unique identifier of the document instance within the RDA registry and which must be assigned by the RDA during the document indexing. Therefore, in this process, the healthcare facility establishes, on one hand, which of its documents, in relation to their function, can be discarded over time, in compliance with the legislation that protects cultural heritage, and, on the other hand, which of them require unlimited preservation. The documents which have their duplicate indexed in the FSE need to be flagged as such, through the use of a specific metadata, and preserved as long as the patient's FSE is active. Correspondingly, when the duplicate is sent to the FSE repository, the preservation metadata [11] should be assigned, in order to certify that the duplicate corresponds to an original document preserved according to the law by the healthcare facility that produced it. From this point of view, to assign a value to this metadata is of fundamental importance as it allows us to consider the document indexed in the FSE legally valid even if the validity of the digital signature certificates have expired, since the existence of the original document in the producer's long-term preservation system also guarantees the validity of its duplicate [28]. The value assignment of this metadata should take place after the original document submission to the long-term preservation system, to ensure an accurate and consistent transmission and/or updating of the indexing metadata. The use of the preservation metadata is crucial to face the long-term preservation of and access to FSE documents. It is already part of the metadata schema defined in the AD Italy, but in fact its usage is infrequent and consequently its importance is largely underestimated, since it contributes to guarantee the original document preservation; the authenticity of digital resources over time; the document relationships between original documents and duplicates; and the decision-making in the preservation process [35] (e.g., decisions about the time of preservation of each document).