How Chile’s IT Architecture is Transforming its Healthcare

by Michael Leppitsch and Aashima Gupta

Not long ago, Soledad Munoz Lopez, the CIO of Chile’s Ministry of Health (MINSAL), faced an enormous challenge.

She and other MINSAL leaders recognized the future of the country’s healthcare system relies on connectivity. Accurate medical records must be available for healthcare providers on-demand, regardless of whether a patient walks into a major hospital or a rural clinic, for example. But Chile’s more than 1,000 remote medical facilities lacked connectivity and many of its healthcare systems could not easily interoperate. An earlier effort to centralize and then copy medical records across all the facilities exploded in costs and fell behind schedule. To meet its goals, MINSAL needed a new approach to IT architecture.

Ms. Lopez is leading the implementation of a national API-based architecture powered by the Apigee API platform. From facilitating smoother public-private partnerships to enabling wider use of services such as telemedicine, the shift is an aggressive move by MINSAL to rapidly improve wellness for its millions of citizens and visitors.

The API-first architecture dovetails into a variety of MINSAL’s healthcare efforts, including a national program to connect unconnected healthcare centers; a plan to digitize all clinic and administrative processes, both for major hospitals and local clinics and primary care centers; strategies to better leverage data and connectivity for public alerts, population health management programs, and the Public Health Surveillance initiatives required for planning and execution of public health policy; and the use of new secure national identity and biometrics services.

Connecting Chile’s Healthcare System

One of the primary areas of concern addressed by the new digital architecture is the ease and speed of integration. As noted above, it is important, for example, that whenever a patient is treated anywhere in Chile, the clinical teams and the patient have access to all the information that has been generated for that patient, regardless of where this information was recorded. This includes data from other health clinics, public or private institutions, laboratories, radiology and images, clinical equipment, etc.

This variety of data sources typifies the diverse heterogeneous environment the API-first architecture needed to address: applications, devices, patient record systems, management systems, scheduling, and so on.

Most of these pieces within the MINSAL ecosystem were never designed to interoperate. Ms. Lopez and other MINSAL leaders chose the API-first approach because APIs abstract this back-end complexity into predictable, consistent interfaces that allow developers to quickly and efficiently connect data, services, and apps across the nationwide system. This way, the developers that are developing and maintaining the hundreds of different software systems in use around the country can quickly and easily exchange data securely between their solutions. The result is a more seamless experience for doctors and patients and a secure but agile infrastructure for MINSAL.

In a previous attempt to efficiently and scalably integrate health records, started in 2005, Chile utilized a centralized SOA-based architecture. This strategy turned out to be an expensive and inflexible way to try and achieve interoperability. The integration expenses were projected to exceed $110 million — untenable in a country where the total budget for development of clinical records is about $40 million annually. But the costs to the users and patients in an unconnected system are far larger, including unnecessary travel, duplication of exams, and out of pocket costs in general.

In collaboration with Google, the company that delivers the Apigee API platform, and local system integrators, MINSAL is implementing a health systems technology investment strategy that is much more efficient. The API-based architecture enables any IT professional in any of Chile’s organizations, facilities, institutions, and providers to onboard their information systems in an organized, secure, self-service manner.

This makes the national program more scalable and involves local industry experts more closely. In addition, these entities can continue to evolve their own local systems as they need, as long as they are compliant with the common integration strategy. MINSAL requires that all data records be based on API-centric standards like FHIR and HL7, with images based on DICOM.

Ms. Lopez explains that all of these connectivity efforts help enable important new services and exciting innovations that benefit Chilean citizens. These benefits include telemedicine, which allows patients to avoid unnecessary travel and relocation while under medical care. Telemedicine in Chile is well-developed in five specialties: teledermatology, teleophthalmology, telenephrology, teleradiology, and tele-electrocardiography.

An API Platform for a Healthy Future

Chile’s API-based strategy is paying off, and as a result, the shift from a SOA-based architecture to an API-based architecture has moved beyond the health sector to become a national strategy, according to Ms. Lopez.

The platform has been the accelerator for the entire program, providing visibility and control that make APIs easy to manage, and saving MINSAL from having to develop API management features that Apigee delivers, such as key management, identity brokering, traffic routing, cyber-threat management, data caching, collection of analytics, developer management, developer portal, and many others. Active API platform projects at MINSAL now include:

• A single registry of individual and Institutional Health providers
• An identity service integrated with the National Identity Registry
• A birth pre-registry and death registry
• A verification of identity service for use during emergency medical services
• A national pharmaceutical terminology service
• A telemedicine and patient portal to support pregnancies
• Electronic immunization and allergy records
• Traceability and management of national health insurance accounts
• An electronic medical prescription model

The API platform helps professionals in the entire network of healthcare systems in Chile access patient information throughout the care cycle, reducing costs through shared information, eliminated delays, and reduced duplication of medical tests. The platform also provides information to apps and websites used by patients, allowing them to see and gradually empower themselves with their own health data.

Consuming information from operational systems, API technology supports the monitoring of epidemiological changes in the population via the same Apigee platform that is already interfacing with all the health establishments. This means the ministry can now have far better data to begin to experiment with artificial intelligence, and use big data to help focus health programs on particular outcomes.

For example, the needs of chronic patients, who consume 80 percent of primary healthcare resources in Chile, are different from the needs resulting from an earthquake or other calamity. Mining the data leads to better efficiency, and better efficacy, for the entire healthcare system, improving the continuity of patient care, users’ personal care, and preventative care.

On the issue of calamities, Chile uses API-driven solutions to help the country and its citizens better respond to a disaster. It uses Google Maps, for example, to georeference events and affected populations to coordinate emergency responses.

Looking Ahead

Looking to the future, the API strategy positions Chile to continue connecting its data, services and apps wherever they are needed, from new hospitals to more sophisticated self-serve healthcare services delivered via wearables and the Internet of Things.

With more and more features enabled by its API platform and nationwide connectivity initiatives, MINSAL is currently expanding its efforts to include partnering with other Chilean institutions to sponsor hackathons and otherwise increase engagement with the country’s entrepreneurial community. The hackathons are designed to encourage the larger ecosystem of software developers, startups, and other institutions to take the capabilities of MINSAL APIs in innovative new directions and combine them with APIs from other government agencies and services providers. The result should be new apps and services that combine healthcare data in novel ways. MINSAL leaders are eager to integrate awareness about wellness and nutritional information into citizens’ daily routines, a goal that third-party apps are better equipped to fulfill than print and other traditional approaches.

Already a leader in Latin American healthcare, Chile is now poised, with its API-based architecture and detailed vision for rapid improvement, to maintain its excellence and provide a model for using technology to improve the lives of millions or people.