Objetivo. Comparar la concordancia diagnóstica entre médicos y codificadores en el uso de la Clasificación Internacional de Enfermedades, 11.ª Revisión (CIE-11). Métodos. Se realizó un estudio piloto en el Hospital San Juan de Dios de Curicó, Chile, entre marzo y junio de 2025, que incorporó la codificación CIE-11 en los servicios clínicos de medicina y psiquiatría. Se capacitó a 8 médicos y 2 codificadores en el uso de la CIE-11 y se utilizó la plataforma nacional Deisy CIE-11 para la validación de diagnósticos. Se analizaron 457 egresos hospitalarios, comparando la codificación diagnóstica realizada por médicos, codificadores y un referente nacional. Resultados. Para el diagnóstico principal, la concordancia fue del 96% (439/457) con el codificador y del 93% (424/457) con el referente nacional. En los diagnósticos secundarios, la concordancia fue superior al 90% en todos los campos evaluados. El coeficiente kappa de Cohen entre médicos y codificadores fue de 0,963. Los principales errores se asociaron a omisiones en la postcoordinación y a la ubicación incorrecta del código de causa externa. El referente nacional revisó el 100% de los registros con información disponible. Conclusiones. Este estudio piloto mostró una alta concordancia diagnóstica entre médicos, codificadores y el referente nacional en la codificación de egresos hospitalarios. No obstante, se identificaron brechas relevantes en la postcoordinación, en el registro de causas externas y en la estandarización de los criterios de revisión. Estos hallazgos aportan evidencia inicial para orientar futuras estrategias de implementación de la CIE-11 en la morbilidad hospitalaria.

Cardiovascular diseases are the leading cause of mortality worldwide, including in Chile, accounting for about 23

CardioCx is a health information system for complex and high-risk cardiac procedures designed and developed in Chile. It is currently utilized to register cardiac surgery interventions at the Grant Benavente Hospital Cardiovascular Centre in Concepción. After ongoing development, modifications, and enhancements, the registry now includes 3,415 high-risk and complex cardiac procedures (the most comprehensive database in Latin America), comprising Isolated CABG (1,732), Isolated Valves (1,207), Combined CABG + Valves (224), and Others (252). The platform adheres to the standards of global cardiac surgery registries, enabling accurate data entry, consultation, and export for clinical analysis. Its architecture ensures interoperability with HL7 FHIR and incorporates an Artificial Intelligence layer for advanced analysis.

Interoperability in healthcare systems is a fundamental requirement to ensure the continuity of care for the population. The Fast Healthcare Interoperability Resource (HL7 FHIR) is the standard for interoperable systems and is widely adopted globally. This article introduces a web platform for creating, implementing, deploying, and automatically assessing online courses for training in HL7 FHIR

The Virtual Semiology League was created as a methodology for designing and developing serious games for teaching semiology in medicine. The engineering students designed and developed four clinical semiology serious games collaboratively with medical students to teach and learn the symptoms and signs of different diseases. Four serious games were developed and validated, focusing on the following topics: 1) Pulmonary and cardiac auscultation, called Auscultologist; 2) Clinical case resolution (for mobile), called Doc Adventure; 3) Immersive abdominal ultrasound simulator, called VR Simulator; and 4) Clinical case resolution (computer role-playing game) with Semiology: A health nap for adventure. The Virtual Semiology League was successful. As an interdisciplinary teaching and learning methodology (Engineering and Medicine), it allowed us to coordinate heterogeneous working groups that complemented each other and learned from each discipline.

Objetivo. Evaluar la concordancia, comparabilidad con versión en uso y usabilidad de la Clasificación Internacional de Enfermedades, undécima revisión (CIE-11), que introduce una mayor granularidad, está diseñada para entornos digitales y ofrece mejoras respecto a CIE-10. Método. Se seleccionaron 2 000 certificados médicos de defunción del año 2020 mediante muestreo estratificado proporcional. Dos codificadoras expertas y un equipo gold standard (GS) codificaron los registros con el uso de la herramienta oficial de CIE-11. Se la evaluó la concordancia entre GS y codificadoras expertas en las glosas inmediatas, originarias y la causa básica de defunción (CBD). Se comparó la distribución por capítulos de CIE-11, CIE-10 en la base original y CIE-10 mapeado desde CIE-11. Resultados. La concordancia con precisión clínica varío entre un 37% para la CBD y un 76% para la causa inmediata. La concordancia del código base varió de un 73% para la CBD y un 86% para las causa inmediata y originaria. El índice kappa de Cohen para la CBD fue de 0,68 (IC95%: 0,64 - 0,72) para la codificadora 1 y de 0,76 (IC95%: 0,73 - 0,80) para la codificadora 2, concordancia que se considera sustancial. La distribución de CBD para CIE-10 y para CIE-10 mapeado desde CIE-11 fue similar. Conclusiones. Se observa una adecuada concordancia y comparabilidad de CIE-11, respecto a CIE-10. La usabilidad de la herramienta es alta, lo que confirma la factibilidad de la implementación de CIE-11 en Chile, y subraya la necesidad de capacitación continua y mejoras tecnológicas.

Background:Cardiac surgeries in Chile lack a national registry for systematic data collection and analysis, limiting insights into procedural outcomes and patient demographics. In response to this gap, we developed a web-based platform to support the documentation of high-complexity cardiac surgeries. Objective:This study aimed to design, develop, and implement a cardiac surgery data collection and analysis platform that conforms to international standards to support clinical decision-making and research initiatives. Methods:A web-based platform was developed using the model-view-controller architecture, incorporating input from health care professionals and based on the fourth European Association for Cardio-Thoracic Surgery adult cardiac surgical database report. The platform captures more than 160 clinical variables across 15 categories, spanning preoperative, intraoperative, and postoperative stages. Results:The most significant outcome of this study is the development of the first online platform for documenting cardiac surgeries in Chile. Since its implementation in 2014, the platform has documented more than 4800 cardiac surgeries, establishing it as the largest database for a single institution in Latin America. The platform offers real-time access to data, supports planning and resource allocation, and enables the systematic evaluation of clinical outcomes. Integrating the European System for Cardiac Operative Risk Evaluation II risk model enables a standardized assessment of mortality risk. Conclusions:The platform contributes to the collection of cardiac surgery data in Chile, enabling evidence-based clinical decision-making and informed public health planning. It has documented cardiac surgeries for 10 years and has become the official registry tool for cardiac surgeries. By 2026, its application will be extended to 2 more centers, with the expectation that it will soon become the national database of cardiac surgeries. Future developments should improve scalability, interoperability, and data analysis to establish a national registry and further align Chilean cardiac surgery practices with international standards.

Interoperability in healthcare systems is a fundamental requirement to ensure the continuity of care for the population. The Fast Healthcare Interoperability Resource (HL7 FHIR) is the standard for interoperable systems and is widely adopted globally. This article introduces a web platform for creating, implementing, deploying, and automatically assessing online courses for training in HL7 FHIR.

The European-Latin American Consortium towards Eradication of Preventable Gallbladder Cancer (GBC) - EULAT Eradicate CVB is collecting high-quality data and samples in four Latin American countries with a high incidence of GBC: Argentina, Bolivia, Chile and Peru. The goal is to build a unique biorepository integrated with a customized informatics platform, identify, validate, and functionally characterize novel GBC risk biomarkers, and develop GBC prediction models integrating epidemiological and genetic-molecular risk factors. We decided to develop the electronic data collection application EULAT eCollect to facilitate the retrieval of socio-demographic, clinical, lifestyle, nutritional, and sample information from the 15,000 Latin Americans we are enrolling. The EULAT eCollect app reduces the time spent by study participants, limits the use of paper and ink, minimizes the costs and errors associated with completing written forms and their subsequent digitization, and allows close monitoring of local recruitment rates and data quality. We describe in this article the design and implementation of EULAT eCollect, which started with the specification of functional and non-functional requirements and ended with the implementation and subsequent validation of the four application modules: I Socio-demographic interview, II Sample information, III Case report form, and IV Food frequency questionnaire. We present both general and technical results and our experience with the Open Data Kit software, which may be of interest for future research projects, especially those on personalized cancer prevention conducted in low- and middle-income regions.

Background: Major depression (MD) is a prevalent and disabling condition in Chile. Most MD cases are treated at the primary care level. In Chilean primary care, the authors have gathered evidence of a prevalent complex depression subtype associated with a worse prognosis and characterized by interpersonal difficulties, suicidality and trauma history. This MD presentation suggests the need for a multidimensional, trauma-informed and interprofessional approach. The present study protocol describes the context, hypotheses and methods for a cluster randomized control trial (RCT) comparing a collaborative multidimensional approach and usual care in treatment outcomes of MD in primary care in Chile. Methods: This is a two-arm, single-blinded, cluster RCT to compare the efficacy of a collaborative multidimensional approach for depression (CMAD) versus usual care to treat MD in primary care clinics in Chile. In total, 394 depressed adults from 18 to 65 years of age in twelve clinics located in Chile’s Maule Region will be consented to participate in the study. Patients and care teams from each clinic will be randomized to the intervention or to the control arm. Interprofessional teams in the intervention arm will attend 27 hours of didactic and active learning sessions focused on clinical competences to effectively engage, treat and follow up patients with complex presentation of MD. Team in the control arm will receive 27 didactic sessions on current clinical guidelines for MD, professionals in both arms will receive 27 hours of continued education. Discussion: To improve treatment outcomes of MD in Chile, primary care teams should develop clinical competencies relevant to complex, difficult-to-treat types of MD within collaborative and trauma-informed approaches.

The development of complex technological systems in healthcare often faces challenging information integration problems that do not always have a complete solution. This paper proposes using model-driven software engineering concepts to address these issues. Specifically, we analyze scenarios involving information sources with predefined data models and information sources with changing data models conforming to a common meta-model. We propose the creation of tailored transformation chains adapted to these scenarios. The approach is illustrated through the creation of an ecosystem for standardized educational material generation by integrating Mosaico (a tool for collaborative production of clinical cases), Clavy (a platform for flexible management of digital object collections), and Moodle (a widely used learning management system).

Cardiac surgeries in Chile lack a national registry for systematic data collection and analysis, limiting insights into procedural outcomes and patient demographics. In response to this gap, we developed a web-based platform to support the documentation of high-complexity cardiac surgeries. Design, develop and implement a cardiac surgery data collection and analysis platform that conforms to international standards to support clinical decision-making and research initiatives. A web-based platform was developed using the Model-View-Controller (MVC) architecture, incorporating input from healthcare professionals and based on the fourth European Association for Cardio-Thoracic Surgery (EACTS) adult cardiac surgical database report. The platform captures over 160 clinical variables across 15 categories spanning pre-operative, intra-operative, and post-operative stages. The most important result of this study is the creation of the first online platform for documenting cardiac surgeries in Chile. Since its implementation in 2014, the platform has documented over 4,800 cardiac surgeries, establishing it as the largest database for a single institution in Latin America. The platform offers real-time access to data, supports planning and resource allocation, and enables the systematic evaluation of clinical outcomes. Integrating the EURO SCORE II risk model facilitates a standardized mortality risk assessment. The platform contributes to cardiac surgery data collection in Chile, enabling evidence-based clinical decision-making and public health planning. It has documented cardiac surgeries for 10 years and has become the official hospital registry tool. By 2025, its application will be extended to two more centers, with the expectation that it will soon become the national database of cardiac surgeries. Future developments should improve scalability, interoperability and data analysis to establish a national registry and further align Chilean cardiac surgery practices with international standards.

BACKGROUND:Interoperability between health information systems is a fundamental requirement to guarantee the continuity of health care for the population. The Fast Healthcare Interoperability Resource (FHIR) is the standard that enables the design and development of interoperable systems with broad adoption worldwide. However, FHIR training curriculums need an easily administered web-based self-learning platform with modules to create scenarios and questions that the learner answers. This paper proposes a system for teaching FHIR that automatically evaluates the answers, providing the learner with continuous feedback and progress. OBJECTIVE:We are designing and developing a learning management system for creating, applying, deploying, and automatically assessing FHIR web-based courses. METHODS:The system requirements for teaching FHIR were collected through interviews with experts involved in academic and professional FHIR activities (universities and health institutions). The interviews were semistructured, recording and documenting each meeting. In addition, we used an ad hoc instrument to register and analyze all the needs to elicit the requirements. Finally, the information obtained was triangulated with the available evidence. This analysis was carried out with Atlas-ti software. For design purposes, the requirements were divided into functional and nonfunctional. The functional requirements were (1) a test and question manager, (2) an application programming interface (API) to orchestrate components, (3) a test evaluator that automatically evaluates the responses, and (4) a client application for students. Security and usability are essential nonfunctional requirements to design functional and secure interfaces. The software development methodology was based on the traditional spiral model. The end users of the proposed system are (1) the system administrator for all technical aspects of the server, (2) the teacher designing the courses, and (3) the students interested in learning FHIR. RESULTS:The main result described in this work is Huemul, a learning management system for training on FHIR, which includes the following components: (1) Huemul Admin: a web application to create users, tests, and questions and define scores; (2) Huemul API: module for communication between different software components (FHIR server, client, and engine); (3) Huemul Engine: component for answers evaluation to identify differences and validate the content; and (4) Huemul Client: the web application for users to show the test and questions. Huemul was successfully implemented with 416 students associated with the 10 active courses on the platform. In addition, the teachers have created 60 tests and 695 questions. Overall, the 416 students who completed their courses rated Huemul highly. CONCLUSIONS:Huemul is the first platform that allows the creation of courses, tests, and questions that enable the automatic evaluation and feedback of FHIR operations. Huemul has been implemented in multiple FHIR teaching scenarios for health care professionals. Professionals trained on FHIR with Huemul are leading successful national and international initiatives.

Background:The creation of computer-supported collaborative clinical cases is an area of educational research that has been widely studied. However, the reuse of cases and their sharing with other platforms is a problem, as it encapsulates knowledge in isolated platforms without interoperability. This paper proposed a workflow ecosystem for the collaborative design and distribution of clinical cases through web-based computing platforms that (1) allow medical students to create clinical cases collaboratively in a dedicated environment; (2) make it possible to export these clinical cases in terms of the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) interoperability standard; (3) provide support to transform imported cases into learning object repositories; and (4) use e-learning standards (eg, Instructional Management Systems Content Packaging [IMS-CP] or Sharable Content Object Reference Model [SCORM]) to incorporate this content into widely-used learning management systems (LMSs), letting medical students democratize a valuable knowledge that would otherwise be confined within proprietary platforms. Objective:This study aimed to demonstrate the feasibility of developing a workflow ecosystem based on IT platforms to enable the collaborative creation, export, and deployment of clinical cases. Methods:The ecosystem infrastructure for computer-supported collaborative design of standardized clinical cases consists of three platforms: (1) Mosaico, a platform used in the design of clinical cases; (2) Clavy, a tool for the flexible management of learning object repositories, which is used to orchestrate the transformation and processing of these clinical cases; and (3) Moodle, an LMS that is geared toward publishing the processed clinical cases and delivering their course deployment stages in IMS-CP or SCORM format. The generation of cases in Mosaico is exported in the HL7 FHIR interoperability standard to Clavy, which is then responsible for creating and deploying a learning object in Moodle. Results:The main result was an interoperable ecosystem that demonstrates the feasibility of automating the stages of collaborative clinical case creation, export through HL7 FHIR standards, and deployment in an LMS. This ecosystem enables the generation of IMS-CPs associated with the original Mosaico clinical cases that can be deployed in conventional third-party LMSs, thus allowing the democratization and sharing of clinical cases to different platforms in standard and interoperable formats. Conclusions:In this paper, we proposed, implemented, and demonstrated the feasibility of developing a standards-based workflow that interoperates multiple platforms with heterogeneous technologies to create, transform, and deploy clinical cases on the web. This achieves the objective of transforming the created cases into a platform for web-based deployment in an LMS.

Introduction: In April 2020, the COVID-19 pandemic forced higher education institutions to close their doors. Health sciences students were left without the opportunity for internships and rotations due to the confinement, closure of universities and collapse of hospitals. Professors had to reconvert face-to-face activities into distance learning workshops delivered online. The study aims to identify and analyse the main online clinical simulation activities carried out in Chile during the COVID-19 pandemic between 2020 and 2021, the problems the centres faced, and the protocols they defined for their reopening.

The information produced during clinical practice is of unquestionable value from a didactic point of view. Thus, there is a need for methods to generate educational content from this information in an agile, effective, and automatable way. This paper proposes a method that transforms clinical cases coded in the HL7 clinical interoperability standard FHIR into educational content compliant with the IMS CP standard. To demonstrate the feasibility of the method, we describe an implementation using the collaborative clinical case design platform Mosaico as the FHIR case provider and the Clavy digital collection management platform to transform these FHIR cases into IMS CP e-Learning content, ready to be deployed in a Learning Management System (LMS).

BACKGROUND EuroSCORE II is a mortality risk score for cardiac surgery in adults. This version is widely validated and compared with other scores in Europe, North America, and Asia. AIM To determine the performance of the EuroSCORE II for the prediction of mortality in cardiac surgeries in Latin America. MATERIAL AND METHODS A systematic review was carried out of studies from Latin American countries evaluating the performance of EuroSCORE II in cardiac surgery. The inclusion criteria were patients older than 18 years, from Latin America, published in English, Spanish and/or Portuguese, between the years 2012 to 2020, with the term "EuroSCORE II" in the title. Observed mortality and estimated mortality data by EuroSCORE II were extracted. The calibration was determined by the observed/estimated mortality ratio and the discrimination was evaluated using receiver operating characteristic (ROC) curves. RESULTS Four articles met the inclusion criteria, including 8372 patients. The average patients' age was 62 years and 34% were women. The observed and Euroscore II estimated mortality figures were 7.08 and 3.89%, respectively. The average area under the curve of ROC curves was 0.77 and the observed/ estimated mortality ratio was 2.04. CONCLUSIONS In these studies, EuroSCORE II underestimated mortality in cardiac surgery.

The European–Latin American Consortium towards Eradication of Preventable Gallbladder Cancer, EULAT Eradicate GBC, is collecting high-quality data and samples in four Latin American countries with high gallbladder cancer incidence (Argentina, Bolivia, Chile, and Peru) to build a unique biorepository integrated into a tailored IT platform, to identify, validate, and functionally characterize new risk biomarkers, and to develop prediction models that integrate epidemiological and genetic–molecular risk factors. We decided to develop an application for electronic data collection to facilitate the retrieval of sociodemographic, clinical, lifestyle, dietary, and sample-related information from 15,000 Latin American study participants. The application EULAT eCollect will facilitate the work of study nurses, reduce time spent by participants, limit the use of paper and ink, minimize costs and errors associated with filling out written forms and subsequent digitisation, and support the monitoring of local recruitment rates and data quality. We describe in this article the design and implementation of the EULAT eCollect application, which started with the specification of functional and non-functional requirements, and ended with the implementation and validation of four separate application modules: Socio-Demographic Interview, Sample Information, Case Report Form, and Food-Frequency Questionnaire. We present both general and technical results, and our experience with the free and open-source software, Open Data Kit (ODK), which may be of interest for future related research projects, especially those on personalised cancer prevention carried out in low- and middle-income regions.

EuroSCORE II is a mortality risk score for cardiac surgery in adults. This version is widely validated and compared with other scores in Europe, North America, and Asia.To determine the performance of the EuroSCORE II for the prediction of mortality in cardiac surgeries in Latin America.A systematic review was carried out of studies from Latin American countries evaluating the performance of EuroSCORE II in cardiac surgery. The inclusion criteria were patients older than 18 years, from Latin America, published in English, Spanish and/or Portuguese, between the years 2012 to 2020, with the term "EuroSCORE II" in the title. Observed mortality and estimated mortality data by EuroSCORE II were extracted. The calibration was determined by the observed/estimated mortality ratio and the discrimination was evaluated using receiver operating characteristic (ROC) curves.Four articles met the inclusion criteria, including 8372 patients. The average patients' age was 62 years and 34% were women. The observed and Euroscore II estimated mortality figures were 7.08 and 3.89%, respectively. The average area under the curve of ROC curves was 0.77 and the observed/ estimated mortality ratio was 2.04.In these studies, EuroSCORE II underestimated mortality in cardiac surgery.