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Therapy management is a critical clinical process in terms of patient safety, traceability, and accountability. Chemotherapy is even more challenging, because of different professionals working together, strict protocols, dangerous procedures, costs. Thus, process control, consolidated organizational knowledge and ICT supporting tools become essential for safety and management. Unfortunately, literature does not provide an integrated approach to these issues; national networks of innovation and research can provide better help. Fondazione IRCCS Istituto Nazionale dei Tumori in Milan leads “Towards a complete competence framework and an integrated solution for patient safety in chemotherapy”, a project funded by the Italian Ministry of Health now assessing guidelines, process configurations, risk levels and ICT solutions, in over 20 Italian healthcare organizations. Major results of organizational and technology assessments are here discussed, focusing on the Istituto as a major example of process reengineering and ICT, dealing with Pharmacy centralization, advanced automation, digitalization of drug management, also drawing interesting considerations about impacts and benefits.