AWS Startups Blog

Rebuilding Puerto Rico’s Healthcare Infrastructure in the Cloud

Guest Post By Steve Yaskin, CEO and Co-founder at Health Gorilla, and Ali Zaman, VP of Marketing at Health Gorilla

Over the past decade, there have been tremendous advances in how providers use data to make treatment decisions and coordinate care for their patients. Sharing medical information electronically has become a fundamental need for providers, patients, and vendors, spurring progress across the healthcare industry. Recently announced mandates from the Office of the National Coordinator for Health Information Technology (ONC) are further catalyzing health systems and health technology companies to exchange data via FHIR-based APIs.

At Health Gorilla, we’re committed to making interoperability actionable in real-world clinical practice. We connect health systems to a national data network, allowing providers to retrieve their patient’s clinical history from most major clinical records systems in the U.S. We developed a platform that both aggregates and normalizes data within the health system, and integrates data on care received outside the system, surfacing clinical and strategic insights to drive better care. Central to this effort was the development of a robust cloud-based data platform that could parse through clinical files in a variety of formats and store this data in a queryable CCDA engine. Leveraging AWS, we can ingest and store large amounts of clinical data efficiently and securely for thousands of healthcare organizations across the U.S. and abroad.

The State of Healthcare in Puerto Rico

Despite being a U.S. territory, Puerto Rico’s healthcare landscape is vastly different from the mainland. Federal funding for Medicare and Medicaid is 40-50% lower than the average U.S. state, creating financial strains for hospitals and providers managing those patients. Federal incentives for using electronic medical records are also far lower, with many hospitals and clinics choosing to stay on paper.

In 2017, Hurricane Maria became one of the worst natural disasters to hit Puerto Rico in recent history. For months after the hurricane, many hospitals operated without electricity and clean water. Many healthcare facilities were closed due to physical damages, forcing both physicians and patients to leave the island for care. For those who stayed behind, access to treatment was extremely limited and quality dropped dramatically. Mortality rates from diabetes and hypertension are up 22% and 50% from a decade ago.

Maria’s impact on the state of healthcare in Puerto Rico is still felt today. Most of the physicians who emigrated from the island have not returned, and Puerto Rico continues to lose one doctor per day, on average. Patients who moved to the mainland lost access not just to their physician, but to all of their clinical history, essentially starting their healthcare journey from scratch.

Bring Interoperability to Community Health Centers

In 2018, we started working with the Puerto Rico Primary Care Association Network, a large network of federally-qualified health centers managing the care of over 360,000 Puerto Ricans. These community health centers operate on federal funds, delivering care for patients who are uninsured, underinsured, or homeless. To further increase access to care, a special task force was formed to spur technology adoption across their network of 98 primary care clinics. Interoperability was seen as a fundamental need to properly coordinate care for patients across multiple clinical record systems, labs, and physicians. Clinical data needed to be aggregated, standardized across the network, and queryable to support quality improvement efforts.

Using Health Gorilla’s AWS-hosted platform, we implemented a robust data infrastructure that could ingest data in any format and from any source system, and convert it into a standardized CCDA file. By putting this aggregated dataset into the clinical workflow, we could now empower providers with a full longitudinal history for every patient. This deployment marked the first ONC-certified health information exchange deployed in Puerto Rico, increasing federal EHR incentive payments by over 500%. With this data infrastructure and FHIR API, health technology developers and other collaborators can build new solutions to better serve providers and patients on the island.

Future Direction: Connecting the Caribbean’s Healthcare Ecosystem

Since implementing Health Gorilla with federally qualified health centers, we’ve been accelerating our efforts with new partners in Puerto Rico. We are now implementing our interoperability platform at Sistema de Salud Menonita, an integrated 5 hospital system managing over 250,000 patients. We have also partnered with the National Health IT Collaborative for the Underserved to launch the Medication and Immunization Management Initiative to enable the sharing of clinical records for patients impacted by natural disasters. The goal of this initiative is to improve access to care and reduce health disparities for underserved patients throughout Puerto Rico and the US Virgin Islands.

Our ultimate goal is to connect every provider, hospital, and vendor in Puerto Rico and across the Caribbean on a secure interoperable network. Despite limited federal funding, Puerto Rico has made great strides in rallying support to modernize its healthcare infrastructure. Clinical interoperability has been recognized as a core strategic need to deliver high quality, low cost care for all. We’re excited to be the interoperability partner for many healthcare organizations on the island to improve access to care.

For more information on Health Gorilla, follow us on twitter @healthgorilla or visit our website at