CHILE CONTEXT
Artificial intelligence in medicine in Chile
Artificial intelligence for doctors in Chile can help document care, organize medical history, and consult evidence. Its use must preserve the medical record and professional control.
The same care rule applies to both in-person and remote consultations: relevant information must be recorded completely, promptly, and securely.
Chile Chile
Central document: medical record.
General framework: Law 20,584.
Regulations: Supreme Decree No. 41.
Digital health: same registration duty.
What characterizes a well-managed clinical record in Chile
The Law 20,584 and the Supreme Decree No. 41 They place the medical record at the center of the continuum of care. It may exist on paper, in electronic format, or by other means, but it must maintain complete, authentic, available, and confidential information.
| Timely registration | The information must be incorporated during the provision of the service or immediately after it. |
| Identifiable content | It must be clear who provided the care, when they did so, and what evaluation, instructions, and decisions they recorded. |
| Integration | Each patient must have a central medical record, even if there are specialized records within the facility. |
| Confidentiality | Clinical information is sensitive data and its access must be limited to those who need it for authorized functions. |
| Conservation | The provider must protect the record and keep it available for the period established by regulations. |
The purpose is not to accumulate text: it is to allow another professional to understand the evolution and continue care with reliable information. The Chilean guideline for clinical documentation with AI offers a practical checklist for evaluating drafts and workflows.
MARCO OF CHILE
From the clinical record to digital health services
Chile applies a common framework to public and private providers, both individual and institutional. Reforms on digital health expressly incorporated remote care without creating a parallel record: the registry continues to be part of the medical chart.
Law 20,584
It regulates the rights and duties of patients, professionals, and healthcare providers, including clinical documentation.
D.S. 41
Detail the preparation, content, storage, administration, protection, and disposal of medical records.
Law 21,541
Authorizes remote healthcare services and requires maintaining records under the same terms as in-person care.
Data protection
Providers are responsible for safeguarding sensitive data and controlling the use of technical means, including those of third parties.
University and high-complexity hospitals in Chile
The Chilean network combines public reference hospitals, university centers, and private providers. To observe complex care, teaching, and clinical innovation, institutions such as the following stand out:
Clinical Hospital of the University of Chile
Santiago. University hospital with high-complexity care, specialist training, and research.
UC CHRISTUS Health Network
Santiago. Assistance academic network affiliated with the Pontifical Catholic University of Chile.
Dr. Sótero del Río Hospital
Puente Alto. High-complexity public hospital and reference center for the southeastern area of the Metropolitan Region.
National Thorax Institute
Santiago. National public reference center for respiratory and cardiovascular diseases.
Non-exhaustive selection of reference institutions. This is not a ranking nor does it indicate affiliation with Itaca.
Clinical record, specialized registry, and digital health
An establishment may use various applications and records, but healthcare liability requires that relevant information remains integrated and accessible in the medical record.
| Element | Main function | Responsibility |
|---|---|---|
| Medical record | A person's health history and central record of medical care. | The provider manages, maintains, and protects it. |
| Specialized register | Information maintained by a service or unit for a specific episode or discipline. | You must provide the minimum data defined by the applicable framework to the central record. |
| Digital health platform | Technological medium used for remote care, clinical support, or management. | It does not replace the data sheet by itself nor does it transfer the provider's responsibility. |
Telemedicine maintains the same record-keeping duties
Law 21,541 explicitly incorporated remote care or telemedicine. Providers must maintain records under the same terms as in-person care and use means appropriate to the type of service.
If AI is used, the provider remains responsible for the regularity and safety of care. The technology vendor does not replace the obligation to inform, document, control access, and review the clinical outcome.
Scope: The specific application depends on the type of service and the applicable technical standards. Each institution must review its regulatory, contractual, and security context.
Five questions to evaluate a tool
- Is the required acceptance or consent recorded?
- Can the professional correct the draft before incorporating it?
- Does the institution control permissions, traceability, and preservation?
- Does the relevant information reach the central record?
- Is the technological medium adequate for the provision?
Where AI can contribute to Chilean clinical practice
AI is most useful when it reduces repetitive tasks without separating the professional from the medical record or further fragmenting information across applications.
Documentation
Prepare draft progress notes, notes, summaries, and reports for review.
Coordination
Apply shared structures between services and facilitate the transfer of pertinent information.
Evidence
Synthesize medical sources for specific clinical questions and make the references visible.
Continuity
Sort longitudinal history to retrieve relevant context during care.
AI does not solve interoperability, document quality, or data protection on its own. It is a support layer that must fit into the institution's controls and systems.
ITHACA IN CHILE
Itaca prepares clinical drafts. Your institution retains the official record.
Itaca helps turn conversations, documents, and quick notes into structured clinical drafts. It also allows working with templates and longitudinal context depending on the contracted functions.
The professional reviews and approves the content. The provider retains responsibility for the clinical record, access, custody, and integration with its systems.
Official sources for further reading
- Law 20,584: rights and duties in health care.
- Supreme Decree No. 41: Medical records regulations.
- Law 21.541: remote healthcare and telemedicine.
- Security and privacy in clinical notes with AI.
Editorial and source review: Itaca team. Updated: September 11, 2026. This content is informational and does not replace legal, regulatory, or security advice. Always verify the current version and the obligations applicable to your institution.
Frequently Asked Questions about Medical AI in Chile
Can the medical record be electronic?
Yes. It can be kept on paper, electronic media, or another medium, provided that integrity, availability, authenticity, and confidentiality are ensured.
Should a teleconsultation be recorded as an in-person care visit?
The law requires maintaining records of digital health services in the same terms as in-person care.
Can AI approve a note on behalf of the professional?
No. It can prepare a draft, but the professional must review it and decide what is included in the file.
Does using a third-party vendor shift the responsibility?
No. The provider retains responsibilities regarding security, records, and data processing, without prejudice to the supplier's own obligations.
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