The growing focus on the resilience of road infrastructures has driven the scientific and technical community towards the development of quantitative indicators for assessing the structural health of bridges. Within this context, the concept of the Bridge Health Index (BHI) emerges as a synthetic metric capable of representing the functional, structural, and managerial condition of a structure, including its seismic risk. Internationally, the evolution of BHIs is driven by the need for intelligent monitoring systems, automated evaluation algorithms, and data-driven risk management policies. In Italy, the Guidelines for the classification and risk management, safety assessment, and monitoring of existing bridges and the Operational Instructions issued by ANSFISA outline a coherent path towards the adoption of index-based models. These include knowledge levels, synthetic risk indices, and surveillance systems based on visual inspections, diagnostic testing, and instrumental monitoring. This contribution offers a critical reflection on the integration between international methodologies and national regulations, highlighting the potential of an advanced BHI capable of incorporating structural, geotechnical, and seismic parameters into a unified assessment framework. The objective is to support the development of operational tools for intervention planning, priority management, and seismic risk mitigation, in line with performance-based engineering principles and the digital twin paradigm applied to infrastructure.