With AWS, Uruguay Deploys Vaccination Appointment System in Record Time

The Challenge

In response to the health crisis, Salud.uy, Agesic and the Ministry of Public Health developed a digital strategy to fight Covid-19, which includes the creation of new digital communication channels. These new channels were developed in an effort to reach more people with quality information, prevent the overloading of health care facilities and reduce the demand for telephone assistance. As part of this digital strategy, a virtual assistant was developed for the websites of state agencies and of public and private health care providers to provide information on the pandemic and its progression in the country.

This virtual assistant was integrated into WhatsApp and Facebook Messenger platforms to share prevention measures and other recommendations for the public. In addition, the Coronavirus UY application was created to assist the population when contacting health services. Once they have been identified as a clinical case, people can enter their daily symptoms and communicate via telemedicine with their health care provider's staff directly.

As vaccines began to arrive, the government devised a plan to determine who should be vaccinated first. Initially, the appointment systems used in previous vaccination campaigns were used.

"The tests carried out revealed that the system could potentially experience access and scalability issues," explains Laura Rodríguez, Technology Director at Agesic.

The organization faced the challenge of creating a scalable system as quickly as possible, with enough capacity to allow thousands of simultaneous users to request a vaccination appointment, and without the risk of failing to record anyone's willingness to be vaccinated.

“In addition, the government announced that vaccinations would also be available for adolescents aged 12-17, which posed an additional challenge for the appointment system, not only because of the number of people who would try to register, but also because they are the ones who use digital channels the most,” says Pablo Orefice, Director of Salud.uy.

"This had to be deployed as soon as possible, to prevent the software from becoming an obstacle to the vaccination campaign,” recalls Ms. Rodriguez. Thus, the best and quickest solution was sought, which would allow the Ministry of Public Health to serve all eligible Uruguayans interested in being vaccinated. GeneXus, one of the technology service providers, was in charge of designing and developing the solution in collaboration with other service providers such as BigCheese, QAlified, Inswitch and experts from Amazon Web Services. Together with Agesic's technical areas, they conducted an analysis of the current challenges and the ideal architecture to ensure optimal performance of the appointment request system for the vaccination campaign in Uruguay.

Gastón Milano, GeneXus CTO, explained that keeping the entire system on-premise and upgrading the data centers would have been more expensive and taken much longer. "Elastic Cloud on AWS allows customers to quickly add server capacity to handle a sharp increase in demand. Later on, they stop using this additional capacity and ensure greater efficiency and cost-effectiveness," said Milano. The executive added that the system was deployed in a record time of two days.

Gabriel Hernández, Agesic's Director of Infrastructure and Operations, states that the biggest change they had to implement was moving from a synchronous scheme, such as the one used by the previous system, to an asynchronous one. The new infrastructure acts as a protective layer to prevent the old appointment scheduling system from overloading and becoming unresponsive to those trying to make an appointment. "The solution was to create a protective layer with Amazon Web Services to support peak demand and deliver information so that the appointment system could consume it at a better rate, without directly serving the public," explains Mr. Hernández.

Agesic’s system uses Amazon Simple Storage Service (Amazon S3) for storage purposes, as well as Amazon API Gateway and AWS Lambda for data protection and Amazon DynamoDB for queries. The entire development is based on a serverless model with functions as services. Mr. Hernández also adds that having AWS SDK to make programming even simpler was essential.

Data protection was a key issue in the process. Although Agesic had internally used cloud services for testing before, it had never used cloud technology for live solutions. "We examined the current regulations to ensure that the use of cloud technology for the new system was fully compliant with the law," says Ms. Rodriguez. Due to the importance of protecting information, the agency reported to and requested approval from Uruguay's Regulatory and Personal Data Control Unit, describing the solution's operation and handling of personal data. The solution provides encryption of personal data when uploaded to the cloud, and its configuration ensures that the servers used are located in countries that comply with Uruguay's personal data protection regulations. By adopting AWS services, the Ministry of Public Health managed to provide a new appointment scheduling system for the vaccination campaign in Uruguay. The protective layer implemented has helped, above all, to avoid the frustration of citizens when trying to make an appointment for vaccination.
 
"We used the containment layer and performed extensive testing before going live. Also, we greatly increased the system’s capacity. The cost was low for that capacity level and ensured that the system was able to record requests from 800,000 people without any difficulties," says Hernandez.

“Through the new system and its various channels (web, WhatsApp and app), all users will always receive an answer, enter their data and be placed on a waiting list. Later on, slots will be assigned in an organized manner according to the order of request submission," says Mr. Orefice. As a result, people don't have to wait for the systems to assist them, and eventually enter their data more than once. It gives them peace of mind to know that when the system finds an available slot for their priority group, it will make the appointment and notify them via text message or email. "Users can also track their individual situation on the web, WhatsApp or the Coronavirus UY app, regardless if they are still on the waiting list or need information on their assigned vaccination place and time for both the first and second doses," Orefice explains.

Besides providing an optimal service to Uruguay's citizens, the new system allows the government to more accurately monitor the population's demand for vaccination. "Before, we didn't know who had been rejected when trying to access the system, where they were or how many they were. Today, we know exactly what percentage of the adult population (currently more than 70%) is willing to be vaccinated and where these people are located. It is an essential tool for planning vaccination logistics throughout the country," he says.

Uruguay now has a flexible solution to continue the vaccination program aimed at reaching the entire adult population (2,800,000 people) in the country.

Hernández, of Agesic, notes that from a business perspective it was an excellent idea to include billing into the system because it allows knowing how resources are spent and how costs can be optimized. "We had the chance to monitor the system’s performance in real time," he adds. "This insight also enabled our team to focus on the critical aspects and protect the ultimate asset, which is the personal data of those who submit requests and its subsequent processing." By the end of April 2021, of the 2.8 million people who are eligible for vaccination (82% of the population), 2 million (58%) have scheduled an appointment, 1.2 million (35%) have been given an initial dose, and 600,000 (17%) have been given the second dose.

According to Gabriel Hernández, the first project that uses cloud technology for deployed services opens the door to understanding how new architectures could be integrated into other government services. "This new system complies with the local legislation and allows us to start evaluating, in an efficient and secure manner, the use of cloud services for building and evolving systems," he says. "It is an opportunity to incorporate cloud services in other areas."


*The original publication of this article is available on the Amazon Web Services website.