The information you share Here we identify the role your organization plays when information goes out or comes in. That tells us what you would need to implement.
With laboratory tests, your organization… For example: a hospital that sends samples to an outside lab "orders" them; the lab that processes them "performs" them.
Performs them and delivers the results Orders them from others and receives the results Both We don't work with laboratory tests
With medical imaging (X-ray, ultrasound, CT, MRI), your organization… Performs the studies and writes the report Performs the studies, but someone else writes the report: it orders and receives it Orders studies from others and receives images or reports Performs studies and also orders them from others We don't work with medical imaging
Who do you need to exchange clinical information with? Tick all that apply, even if the exchange happens on paper today.
Public institutions (social security, Ministry of Health…) Other hospitals or clinics Outside laboratories Outside imaging centers Pharmacies Insurers Patients themselves No one for now
Today, how does that information reach you or how do you send it? Tick every way you use, even occasionally.
On paper or printed By email or WhatsApp, as an attachment On USB sticks, CDs or DVDs By logging into the other institution's portal or system Systems connect directly, through custom-built connections Systems connect using standards (HL7, FHIR, DICOM) I don't know
Your systems By "system" we mean any software where information is recorded: the patient record, billing, the lab, even a shared Excel sheet.
How many different systems do you use to record patient information? One 2 to 3 4 to 10 More than 10 I don't know
Which of these do you have? Tick all that apply.
Electronic health record Laboratory system Imaging system (RIS or PACS) Pharmacy system Scheduling Billing Administrative system or ERP Systems built in-house Spreadsheets (Excel) as the main record Microsoft 365 (Excel, Word, SharePoint, OneDrive) Google Workspace (Sheets, Docs, Drive) Other shared cloud folders (Dropbox or others)
If you know them, what are those systems called or who provides them? Optional. For example: "record from company X, lab on system Y".
Do your systems talk to each other? No. Each works on its own and the same information is typed several times Some do, by exporting and importing files by hand Several are connected through custom development Most go through a central integration platform They are integrated and use standards (HL7, FHIR, DICOM) I don't know
Is there a document or diagram showing which systems you have, what data each one holds and how information flows between them? This is called a "data architecture". It need not be formal: a diagram someone keeps up to date counts.
There isn't one Something informal, in a few people's heads It exists, but it is out of date It exists, is up to date and has an owner I don't know
Patients and professionals For a patient's information to reach another institution intact, both need to be sure they are talking about the same person.
How do you identify a patient on arrival? By name With the institution's own record number With an official ID document that is checked With the official document, plus an identifier of the institution's own With the document and a unique identifier other institutions also use I don't know
Do you check patient details against an official source, such as the civil registry? No Sometimes, by hand Always, by hand Yes, the system does it automatically I don't know
How often do you find patients with two records, or two people's records mixed up? Often Sometimes Hardly ever, and there is a procedure to fix it I don't know
How do you confirm a doctor or other professional is licensed to practise? That is, registered with their professional body and active.
It isn't checked Only at hiring, by checking documents It is checked periodically with the professional body The system looks it up in a registry of professionals I don't know
How do you record the patient's informed consent? It isn't recorded in an orderly way On paper, filed separately On paper, scanned into the record Digitally, inside the system Digitally, and other systems can check what the patient authorized I don't know
And how do you confirm that consent really came from the patient or their representative? It isn't confirmed With a handwritten signature With a handwritten signature, checking and noting their ID Signed on a tablet or screen, with date and time recorded With a certified digital signature or electronic identity check I don't know
Can your patients see their results or information online? No, they collect it in person We send it by email or WhatsApp Yes, in our own portal or app Yes, and it also reaches other platforms (such as a national health record) I don't know
The national exchange network Costa Rica is moving towards a national network for institutions to exchange information securely, built on a platform called X-Road. Connecting involves legal, technical and operational matters. You don't need to know the platform to answer: each question explains what it asks.
Is your organization connected, or in the process of connecting, to the national interoperability platform (X-Road)? It is the platform that lets institutions query each other's information securely, with permissions and a record of every exchange.
Yes, we are already connected We are in the process It is in our plans, but we haven't started We know of it, but haven't considered it We don't know it I don't know
On that network, your organization would need to… Query other institutions' information (for example, patient or insurance data) Offer its own information to other institutions (for example, results, reports or appointments) Both I don't know
Do you have signed agreements to exchange data with other institutions? On the network, every exchange needs a legal basis: an agreement, a law or a contract stating what data is shared, why and with whom.
We don't have any We are negotiating some We have some, for specific exchanges Yes, and each exchange has its legal basis, data and owner defined I don't know
Can your systems offer or query information through web services (APIs)? An API is a "door" through which one system asks another for data automatically. The national network only carries what goes through those doors.
No Only if the system vendor builds them, at its own price Some systems have APIs Yes, with in-house documented APIs others can use Yes, with APIs that follow a standard such as HL7 FHIR I don't know
Where could you install and keep running the server that connects to the network? Connecting requires a dedicated server (called a "security server") running at all times, with a stable internet connection.
We have nowhere to put it A vendor would have to do it for us In our own data center or cloud, with our team We already have one running I don't know
Does your organization hold digital certificates in its own name, not just personal ones? To connect, the organization and its server identify themselves with their own certificates, separate from each employee's digital signature.
We don't handle certificates Only some people's digital signatures Certificates for our websites and servers (for example, for https) Yes, certificates in the organization's name, with someone in charge of renewing them I don't know
If another institution wanted to query your data, who would decide whether to grant access, and to which data? On the network, each institution authorizes, one by one, who may query each of its services.
It isn't defined The IT team, case by case Management, with legal advice There is a procedure with legal, technical and data protection owners I don't know
Once connected, who would monitor the connection, apply updates and respond to an incident? No one defined Our IT team, during office hours A vendor, under a support contract A team with 24/7 monitoring and incident response I don't know
The network keeps a signed record of every exchange. Have you defined how long to keep it and who may review it? No Partly Yes, with a written policy I don't know
Team, change and investment The last part before your details: who keeps the technology running, how staff are supported through change, and how you plan to fund the next steps.
Who looks after technology in your organization? No one in particular One person, among other duties An outside company under contract Our own team Our own team, supported by outside companies
Which company or companies provide that service? Optional.
When you roll out a new system, how do you prepare staff? We don't: everyone learns as they go With a one-off training With a training plan With a change management plan, with owners and follow-up I don't know
Have you set an investment in interoperability or digital health? No, and we don't know where to start No, but we want to know what and where to invest in There is a budget, but it isn't clear what to spend it on There is a budget and a defined plan
Which areas are you interested in investing in? Tick all that apply, budget or not.
Interoperability with other institutions Electronic health record Telehealth or patient portal Medical imaging (PACS, viewer, reporting) Clinical terminologies and catalogues Digital signature of clinical documents Cybersecurity Infrastructure or cloud Analytics and indicators Change management and training Connection to the national interoperability network
When do you need to make progress? In the next 3 months In the next 6 months Within the next year For now we are just exploring
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