Tech CEO lambasts INEM’s system
Virgílio Bento, the founder and CEO of Sword Health, valued at $3 billion in 2024, had offered to help implement an AI-powered system for INEM’s emergency call handling.
Virgílio Bento, the founder and CEO of the Portuguese digital health unicorn Sword Health, has openly criticized the National Institute of Medical Emergency (INEM), accusing its information system of being “obsolete and fragile.”
In a LinkedIn post, Bento expressed frustration over the failed attempt to implement an artificial intelligence (AI) solution for INEM’s emergency call system, following a series of failures in the systems, which he claims would have improved efficiency and response times.
The controversy began when Bento told the newspaper Expresso that Sword Health had offered to install an AI-driven solution for INEM’s call center free of charge, but the process was blocked due to the “outdated and fragile” nature of the system.
“What we found is alarming,” he said, comparing INEM’s information system to the ill-fated Entre-os-Rios bridge, which collapsed due to lack of maintenance.
“We foresee a disaster, a collapse at INEM, given the current state of its information system.”
Bento also criticized INEM's management and technical staff, arguing that they lacked the necessary skills to handle such a critical system.
“Our team was shocked by the incompetence of the technicians, especially given that this is a critical system where lives are at stake. The system is at risk, and this cannot be allowed to happen. We are speaking freely because we neither have nor seek government contracts. Someone has to say what is happening at INEM. Our team’s feedback is that this is a ticking time bomb.”
INEM Defends System Reliability
INEM swiftly responded to these allegations, stating that its information systems are “reliable and robust,” handling more than 1.5 million emergency calls per year.
In a separate statement released on Friday,, INEM’s Workers’ Committee acknowledged that while improvements in triage technology are needed, it is “absolutely false” to claim that the system is on the verge of collapse.
In a strongly worded response, INEM’s Workers’ Committee rejected Bento’s claims as “alarmist opinions.”
“It is absolutely false that the triage system is a ticking time bomb or on the verge of collapse. One should not confuse INEM professionals with the inability of external companies to implement solutions that, in our view, are unfeasible. This opinion was conveyed to INEM’s Board of Directors and the Minister of Health in December.”
Bento Doubles Down on Criticism
Following the backlash, Bento reiterated his concerns on LinkedIn, highlighting that emergency medical technicians had shown willingness to adopt AI technology, but mid-level management remained resistant to change.
“Interestingly, one would expect opposition to AI from the frontline workers, but they were actually very receptive. This shows their awareness of the challenges they face. A special thanks to them for their openness.”
Despite praising Portugal’s Minister of Health, Ana Paula Martins, and INEM’s president for their interest in the project, Bento pointed to systemic problems.
“It is impossible to achieve anything with mid-level staff who have been in the same position for 10 to 20 years without basic knowledge. Additionally, there is a pathological resistance to change. These two factors explain the state of the information system we encountered. If the system fails, lives are at risk. In our opinion, there is currently no one at INEM capable of fixing the problem in real-time—but perhaps we are mistaken.”
Bento further criticized the country’s dependency on outdated practices: “It is surprising that while Portugal has world-class companies like Critical Software specializing in critical systems, we still rely on underqualified state technicians and companies that feed off the system. Would it be so difficult to redirect the millions paid to Altice towards Critical Software to ensure a job well done?”
Bento expressed a desire to see Sword Health’s AI system integrated into INEM’s operations, but acknowledged that the decision was out of his hands. “If it happens, it will improve the emergency system. If not, at the very least, conduct an audit of the information system to ensure it is robust and failsafe. That alone could prevent a disaster in the future.”
According to Bento, Sword Health’s AI system follows a clinical decision tree designed to quickly assess the severity of emergency situations and dispatch ambulances as efficiently as possible.
However, the company never received access to INEM’s recorded calls, making the system's development significantly more challenging.
The Debate Over AI in Emergency Medicine
The AI model developed by Sword Health has reportedly been completed and was demonstrated on LinkedIn, where employees simulated an emergency call scenario.
However, full testing would require access to INEM’s recorded calls—data that is protected under Portugal’s National Data Protection Commission.
The application of AI in healthcare has been widely studied and recognized as a valuable tool to support medical professionals. However, in the case of Sword Health’s proposal, details about how it would function within INEM remain unclear.
While the company insists its AI would enhance call triage, critics argue that emergency services require a more human-centered approach.
“INEM does not need a substitute system that cannot handle the complexities of human speech and analysis,” the Workers’ Committee stated. “The real solution lies in hiring more human resources.”
The AI initiative at INEM, which was announced last year by Health Minister Ana Paula Martins as a “pro bono” project, now appears to be in limbo.
Neither Sword Health nor the Ministry of Health has provided detailed information on how the AI model would function, how citizen data would be safeguarded, or whether the company would use the data for other purposes.