Intelligent water usage is required in order to target the challenging goals for 2030 and 2050. Hydroelectric power plants represent processes wherein water is exploited as a renewable resource and a source for energy production. Hydroelectric power plants usually include reservoirs, valves, gates, and energy production devices, e.g., turbines. In this context, monitoring and maintenance policies together with control and optimization strategies, at the different levels of the automation hierarchy, may represent strategic tools and drivers for energy efficiency improvement. Nowadays, these strategies rely on different basic concepts and elements, which must be assessed and investigated in order to provide a reliable background. This paper focuses on a review of the state of the art associated with these basic concepts and elements, i.e., digitalization, Industry 4.0, data, KPIs, modelization, and forecast.