Original article: Hospital de La Florida abandona ficha clínica digital propia tras gastar más de $4.200 millones

La Florida Hospital Drops Homegrown Digital Medical Records Project After $4.2 Billion Investment

In 2021, the Eloísa Díaz Clinical Hospital in La Florida launched an ambitious initiative to develop its own electronic medical record system—a digital platform designed to manage patient files, medical orders, bed management, and emergency admissions, among other essential hospital functions. This type of system is typically offered by a select few private vendors at high prices, leading the hospital’s previous administration to pursue a proprietary solution known as HELO, which could also serve as a public asset accessible to any state health facility.

However, after nearly four years of effort and an investment exceeding $4.228 billion, the hospital’s new administration, led by director Enrique Ayarza who took office in December 2024, decided to halt the project in July 2025. This decision was based on missed deadlines, inadequate planning, and what officials termed as an unsustainable «uncertainty» regarding both the completion date and the final development costs.

By October of that same year, all previously invested resources were declared operational expenses, and the administration announced that the service would be put out to tender in the private market.

This decision has sparked controversy within the institution, which is also grappling with a challenging financial situation characterized by shortages of basic supplies, frequent surgery cancellations, and debts that, as confirmed by the administration, are being settled through the 2026 budget.

Officials who supported the HELO project are suspicious of the benefits this decision may present for large hospital software providers, while the General Comptroller’s Office has opened an investigation into how resources were used and the contracting methods employed during the system’s development.

The Crisis of Scarcity and the Weight of a Controversial Decision

The scarcity of resources at Eloísa Díaz Clinical Hospital in La Florida is a daily struggle. According to accounts shared with CIPER, anonymous hospital employees face surgery cancellations due to insufficient supplies, along with delays in exams and other minor interventions. In this context of budget restraints, the decision to abandon a project that had seen an investment of over $4.2 billion after nearly four years of work has sparked discontent among staff.

The electronic medical record system is vital to the functioning of any healthcare facility, as this digital platform not only stores patient files but also manages medical orders, bed availability, emergency admissions, and nursing instructions.

Since its inauguration in 2013, the hospital had been operating with the Thalamus electronic record system from the Spanish company Indra. Yet, after nearly a decade without upgrading, the prior administration, led by Rubén Gennero, decided in 2021 that Thalamus should be replaced.

Consulted employees described the platform as slow, prone to crashing, and incapable of displaying test results, among other flaws. They noted that using it was cumbersome and required extensive training. The discontent was such that staff even nicknamed the system «Ta Malus», a pun reflecting their frustration.

Faced with this diagnosis, the hospital’s management had two options: to tender for a new system from market providers or to develop their own platform, as other public hospitals had done. The latter option was chosen in 2021, under Gennero’s leadership, who managed the hospital from 2020 to 2024.

The Birth of HELO: A Project with Public Interest Goals

The digital medical record project was named HELO and was placed under the supervision of the hospital’s Digital Transformation Department.

In its initial phase, the initiative included a comprehensive gathering and analysis of the hospital’s needs and processes. However, its scope aimed beyond just the La Florida location, aspiring for HELO to become a publicly available asset usable free of charge by any public health center in the country.

During the early years, the development team made significant progress. According to documents accessed by CIPER, at the point of the project’s closure, the HELO team had implemented four of the nine modules intended for development: Admission, Bed Management for inpatients, Referral and Counter-Referral (for health network transfers), and the Patient Portal, a tool enabling users to review information such as tests and clinical documents that recorded over 1,200 monthly visits.

In addition to these modules, three developments were fully completed but not implemented: Inpatient Care, Outpatient Pharmacy, and the clinical history viewer called «Timeline». Two submodules also reached similar statuses, while the remaining system was left incomplete: the Emergency module achieved 58% progress, while the outpatient and scheduling modules were never developed.

The Arrival of New Management and Initial Signs of Change

In December 2024, Enrique Ayarza took over as the new director of the Hospital de La Florida, and from the outset, he made clear his stance on the development of proprietary technology. In an interview with CIPER, he stated that he never agreed with developing an in-house medical record system, as he believes that is not a hospital’s primary objective.

«The core business of a hospital is not developing proprietary technology; rather, it is to care for the population,» he asserted.

Ayarza, who has extensive experience in public health management, including roles at the Metropolitan Occidente Health Service, indicated that to make an objective decision, he requested two parallel evaluations: an internal audit focused on resource expenditures and an external technical assessment by the National Center for Health Information Systems (CENS).

Internal and External Audits That Sealed the Project’s Fate

CIPER accessed both documents, with their conclusions being decisive for HELO’s future.

The internal audit, which analyzed resource expenditures up to July 2025, revealed harsh conclusions that questioned not only the scale of spending but, fundamentally, how the contracting was conducted. Specifically, it highlighted payments made to Apiux Tecnología SPA, the company hired to work alongside hospital staff in the Digital Transformation department.

According to the audit, Apiux received over $2.476 billion between 2022 and July 2025, accounting for nearly 90% of external payments for the project. However, the scrutiny did not center on the amount of money but rather on the contracting practices used. The report accused the hospital of fragmenting purchases, as the company provided similar services through multiple direct deals, contract extensions, and one tender, a practice prohibited by public procurement regulations.

The timeline of contracting reveals a complex process: in January 2022, the hospital held a public tender to contract the service, but the bidding was declared void as the only compliant provider was 88% more expensive than budgeted. After this failed tender, the institution opted to contract Apiux directly, claiming the service was essential. This initial contract was extended and renewed several times, until in June 2023 Apiux won a new tender. However, after that public tender, the hospital once again contracted the same company through a direct agreement and added further contract extensions.

The report warned that direct contracting with the same supplier for the same purpose before and after finalizing the tender could indicate procurement fragmentation, a practice that regulations aim to prevent to avoid evading Comptroller oversight. Additionally, the audit detected administrative shortcomings, such as insufficient documentation for the first direct contract and internal disorganization in the registration and tracking of purchase orders.

Another section of the investigation addressed overtime payments to certain employees associated with the HELO project, characterized in the report as «exuberant.» It highlighted the case of an employee who registered total overtime payments of just over $5 million in 2024. When contacted by CIPER, the mentioned employee stated that «these hours were completed in strict regulatory compliance,» as they are formally approved by the hospital, backed by attendance records, and reflect the effective execution of assigned tasks. The employee added that all required documents «have been timely submitted to the Internal Audit Unit for clarification» and that the amount reported in the report «corresponds to the annual total for 2024 and not to a one-off or monthly event.»

The same report also raised concerns about employees who might have reported overlapping hours while holding contracts with the hospital and concurrently with companies contracted for the HELO project. However, the analysis did not confirm these irregularities but recommended investigating three employees who might have committed the infraction.

Alongside the internal audit, the hospital commissioned a technical analysis from the National Center for Health Information Systems (CENS) to gain an external perspective that could guide their decision. The direct contract amounted to just over $26 million.

«CENS collaborates with all the universities involved in the field and has a well-earned reputation. We stated that we needed an external perspective that could illuminate whether HELO was worthwhile,» explained Ayarza.

The CENS report, delivered to the administration in December 2025, identified a series of weaknesses, but also strengths regarding the HELO project. Among the negatives, the center pointed out the need for a clear definition of «objectives, goals, timelines, and scopes for the software development project,» the performance metrics were «sparse,» and the technical documentation was «incomplete, compromising traceability and future system maintenance.» However, the same report acknowledged that the existing technical documentation is «of good quality, detailed, and extensive.»

The CENS analysis presents some contradictory points. For instance, it criticizes the lack of clear goals but later recognizes that «the information provided by the development team allowed for a clear specification of the established goals.» It also identified the «lack of planning» as a weakness, noting that «a formal end date for development was not identified,» and that planning only includes tentative dates for the Hospitalization, Emergency, and Admission modules. However, further along in the same report, it stated that there is «a detailed and realistic plan for the modules already developed,» which are precisely the same mentioned earlier.

Among the most critical conclusions, CENS determined that the extra cost to complete the HELO project could reach $1.5 billion or more if deadlines are extended.

This point is what director Ayarza emphasized when justifying his decision: «What we see is that this (HELO) is going to take longer and require more development, more time, and more investment. And that is total uncertainty,» he stated to the cited outlet.

Supporters of the HELO project claim that the CENS analysis did not incorporate their explanations and view the latter part of the report with skepticism, where the center recommends the services of three private providers: Intersystems, Rayen, and Indra. In that section, CENS indicates that, in their view, these companies «could meet institutional needs» and includes several paragraphs highlighting the positives of all three firms. However, in the same section, the report clarifies that «this mention does not imply, in any case, a technical or commercial recommendation nor a definitive selection of a technological solution.»

Meetings with Providers and the Shadow of Past Accusations

An aspect that has raised suspicions among HELO defenders is the calendar of meetings that director Ayarza held with information technology service providers in the months leading up to the project halt decision. CIPER verified that between May and July 2025, Ayarza held at least two meetings under the Lobby Law with companies in the industry: InterSystems and Dedalus.

The first meeting, held in May, was with the American company Intersystems, one of the largest firms in the field worldwide. It arrived in Chile over 16 years ago, and its presence within the public health network has expanded exponentially, currently maintaining at least 34 active contracts with various health establishments. In fact, former authorities consulted by CIPER closely watch the progress this company has made in recent years within the Chilean public system.

Ayarza’s relationship with Intersystems is not new. In 2008, while serving as director of the Metropolitan Occidente Health Service, the now-director of La Florida Hospital signed an $11 million contract with Intersystems for the implementation of their TrakCare platform across all hospitals in the service.

As the cited media recalled, that contract ended with hefty fines and accusations of non-compliance that triggered inquiries, Comptroller investigations, and even referrals of the evidence to the Public Ministry, as La Tercera reported in 2013. That year, when the system was supposed to be installed, the director of the health service involved, Juan Kehr, reported that Intersystems’ implementation did not exceed 45%.

When asked about that incident, Ayarza responded: «I was the first to impose a very heavy fine for non-compliance on part of that company.»

The second Lobby Law meeting held by the director was with Dedalus, a multinational company specializing in health software. This meeting took place on July 14, 2025, just four days before the Hospital de La Florida Strategic Committee agreed to halt HELO’s development.

Ayarza justified his decision to terminate the project by stating that there was «uncertainty» regarding the final cost and the time required to make it operational. However, he acknowledged that it is currently impossible to determine how much the hospital will spend on hiring a private digital clinical record through the new bidding process.

«We are evaluating the cost of the new bid. We hope it will be much less than what we have spent on IT systems here, but I don’t have a number,» he admitted.

Internal Dispute and Complaints to the Comptroller’s Office

The conflict surrounding the HELO project did not begin with Ayarza’s arrival. In August 2024, when Rubén Gennero was still at the helm of the hospital, the General Comptroller’s Office received an anonymous complaint alleging misuse of resources and insufficient progress in the platform’s development. The controversy escalated when hospital unions began to accuse enrichment from public funds, suggesting that the project’s money was being used for personal benefits of certain employees.

Regarding this issue, Ayarza dismissed the accusations, stating that «the opinion of some unions was that money had gone to personal interests, a topic that, on examination from all angles, does not appear anywhere. That was the first thing that worried us and needed clarification.»

«What is debatable is whether more or less was invested, but that will always be debatable,» he acknowledged.

On the other hand, HELO advocates who spoke with CIPER, under anonymity, argued that there were no technical reasons to halt the project. They insist that the audits, especially the internal one, did not consider the developers’ explanations and were based on information they consider erroneous or incomplete.

In their view, terminating HELO amounts to throwing away years of work and they are deeply suspicious of the benefits this will bring to private providers participating in future tenders.

They indicated that for those companies, the HELO project posed a real threat, as it would affect their business if it were established as a publicly available asset accessible to all hospitals in the country.

Ayarza, for his part, acknowledged the diversity of opinions within the health establishment but insisted on defending his method for making the decision.

«Everyone has opinions in these matters. Everyone is a football coach, and I, too, had my opinion as a new coach, but I thought it was right to form my conviction as objectively as possible,» he asserted to the investigative outlet.

Debts and Compromised Budgets at La Florida Hospital

As the controversy over HELO’s end continues, hospital unions await the results from the ongoing investigation by the General Comptroller’s Office. Meanwhile, they must continue to deal with the repercussions of insufficient resources affecting the establishment.

The financial situation at La Florida Hospital is critical. According to staff accounts, surgery cancellations due to lack of supplies are a daily occurrence, alongside delays in exams and minor interventions. This year, the outlook does not appear to improve: in an email response to CIPER, the hospital administration confirmed it is addressing outstanding debts using the 2026 budget, indicating they are mortgaging future resources to cover current needs.

In this context of financial strain, declaring the over $4.2 billion invested in HELO as operational expenditure and starting a tender process with private providers, whose costs cannot yet be precisely determined, adds a new element of uncertainty to the already complex situation at the institution.