eHealth - Building Ukraine's National Health Service From Scratch

The Context

Ukraine was going through a massive healthcare reform. The old Soviet-era system was broken in every way you’d expect: clinics got funding based on how many people had a residence address in their region (which was almost always wrong), patient records were handwritten on paper, prescriptions were untraceable, and corruption was rampant at every level.

One day people who wanted to digitalize all of it came to us. They had no money, but a way to create political will. Declarations between patients and doctors, medical reimbursements, e-prescriptions, patient records - the whole thing had to be online. And they wanted it open source, transparent, and, due to existing commitments, in production within about four months 🙃.

The Scale

This wasn’t a startup MVP. This was a system that would eventually serve every person in the country. Nowadays it serves:

• 35M+ patients
• 350k+ healthcare workers
• 16k+ medical facilities
• Billions of records - EMRs, e-prescriptions, declarations

By law, every doctor participating in the reform had to use it starting 2018. There was no “soft launch.”

What We Built

I co-designed the architecture and led the technical side - architecture decisions, security, hiring, and hands-on Elixir development and DevOps. The Nebo #15 team was about 10 engineers plus we were given a few analysts, and a project office on the customer side.

Obviously we couldn’t ship everything in four months, but in six we got Master Patient Index, Operations (mostly declarations for country-wide medical reimbursement) and a few other internal services to production. They were well documented and already integrated by some of the larger Medical Service Providers. And the architecture was already designed for e-prescriptions, EMRs, and more.

The entire codebase was open sourced under Apache license. Every line of code, every architectural decision - publicly auditable. In a country fighting corruption, transparency wasn’t optional. Later it was partially closed due to security regulations though.

What Happened After

The system went live and kept developing and growing. When I last visited a private clinic, they offered to process my visit through eHealth so I wouldn’t have to pay out of pocket. The system I helped build was now part of daily life. I felt really proud of that.

I wrote a detailed technical blog post about the architecture while it was still fresh.

What I Learned

Building for a country is different from building for a company. The stakes are real - not “our metrics dip” real, but “people don’t get medicine” real. It changes how you think about reliability, security, and simplicity.

Also, when anyone can read your code, you write better code.