The diffusion of smart cards within the health field is common in many countries and regions throughout the world. Italy's Regione Lombardia enjoys one of the more successful applications of health information technology in Europe, and the current state of its accomplishments is examined in this article. Other European countries and regions are also using health smart card programs, and some are moving beyond using the card simply for health insurance. Programs in Andalucia, Austria, Belgium, Finland, France, Germany and Slovenia are reviewed here, too.