Abstract Background In Europe, digital transformation of healthcare is one of the agenda priorities. Institutional websites and mobile applications (APPs) have been increasingly adopted by healthcare organizations for communication and service delivery. This study aims at describing the state of art and the variability of healthcare digitalization in Italy. Methods The study focuses on 144 active websites of public healthcare organizations (i.e. Local Health Authorities and Teaching Hospitals) of 11 out of the 21 Regional healthcare systems in Italy. The research investigates whether the healthcare organizations provide e-booking and e-paying for outpatient visits through their website/APP and whether citizens are informed of this opportunity. Researchers independently analyze the websites taking the user’s perspective, by adopting a common grid. Data refers to December 2018. Results The majority of items analyzed show a high variability within and among Regions. The provision of online services patients can benefit of change across the same territory. Almost 76% of the LHAs/hospitals allow for e-booking of outpatient visits and e-paying is available for 84% of them. The adoption of APPs for healthcare is not homogenous. Some Regions develop a specific regional tool (e.g. Apulia, Lombardy) providing uniform access to digital services to their resident population while in other Regions, public healthcare providers can implement their own APP (e.g. Liguria, Veneto). Conclusions Our findings suggest that centralizing digital services - at least at regional level - can enhance healthcare digitalization in Italy, avoiding jeopardized and unequal provision of digital services. Further research should investigate the actual use of these services by citizens and the reasons of variability. Key messages Italy is in delay in digital transformation of healthcare. Our study supports the identification of good regional practices, which could endorse the implementation of future actions.