This paper reviews the history and development of biological water quality assessment using macroinvertebrates in Italy. Italy was one of the first European countries to officially adopt a biomonitoring system based on benthic invertebrates, the Indice Biotico Esteso (IBE). After the European Water Framework Directive (WFD) 2000/60/EC, this method was replaced by the “Standardisation of River Classifications_Intercalibration Common Metrics” (STAR_ICM) index, which met the new requirements. As this method has been employed for some years, it could be useful to take a provisional stock and to provide some suggestions to ameliorate the current biomonitoring approach, also trying to minimize the break with past practices and better harmonize the history of biomonitoring in Italy. One of the most evident difference between past and current approach is related to the amount of time and effort required in the application of the two methods. STAR_ICMi is a scientifically rigorous and modern method, but much more time-consuming and challenging in both field and laboratory efforts. This fact has various disturbing practical repercussions, i.e., the environmental agencies have generally reduced the number of sampling stations routinely monitored during the year. The aim of our work is to propose some operational changes that would help to simplify and expedite the monitoring process. In particular, regarding fieldwork, we focus on the time and effort required for macroinvertebrate collection, while for laboratory activity we suggest a reshaping of the requested taxonomic detail. Moreover, in this way the data provided by the new approach could be compared with the long time series available from the previous application of IBE.