Three decades of telemedicine in Brazil: Mapping the regulatory framework from 1990 to 2018 (original) (raw)

Telemedicine: challenges to dissemination in Brazil

Cadernos de Saúde Pública, 2016

Telemedicine has been seen as an important tool for facing the challenges of universal health systems. The goal of this article is to discuss the main challenges to its full dissemination in Brazil. Being a somewhat new area, there are not many scientific papers that systematize it. This article is an exploratory paper, as it aims to provide an overall perspective on the subject. From an economic point of view, telemedicine is a strategic area due to its an intrinsic potential of being a source for generating innovation, for requiring and incorporating technological breakthroughs from other areas, and for its interdisciplinary nature and dynamic interrelations that drive different industries. From the social perspective, it has the potential to make access to health services democratic, by connecting remote regions with health services located in hospitals and centers of reference for prevention, diagnosis and treatment.

Brazilian Telemedicine Networks

2008

One of the outcomes of the telemedicine evolution was the emergence of telemedicine networks which can be characterized as the interconnection of centres or healthcare professionals to provide telemedicine services. This paper aims to present a study of the characteristics of the Brazilian telemedicine networks. For the implementation of this study and the selection of the projects, the authors proceeded a search and revision of articles and sites obtained in the Google and PubMed repositories. As conclusion, the existence of two types of networks was verified: infra-structure and telemedicine service; all of the networks are based on asynchronous telemedicine, most of them acting in inter-cities, nevertheless there are not telemedicine cases inside the own municipal district to eliminate socioeconomic barriers; there were not find inside these networks projects or initiatives to regulate the remuneration of the professionals involved in the processes as well as, the payment for the services that were used.

A Statewide Telemedicine Network for Public Health in Brazil

2006

The use of modern telecommunications technologies like telemedicine and the internet it's essential to decrease the centralization of the Brazilian's public healthcare service, and to improve the access to specialty care in small-tows and rural localities. In this paper, we describe the development and implementation of a public statewide telemedicine network in the Brazilian's State of Santa Catarina.

Telehealth in Rio Grande do Sul, Brazil: Bridging the Gaps

Introduction: In 1988, Brazil adopted a universal healthcare model in which access is mediated by the primary care level. However, difficulties have emerged in the coordination of care between the primary and specialized levels. Telehealth was thus proposed as a means to overcome this challenge. This article describes initiatives developed by a large Brazilian program , TelessaúdeRS/UFRGS, in the fields of teleconsultation, telediagnosis, tele-education, and information technology development to support the public healthcare system. Materials and Methods: TelessaúdeRS/UFRGS was established in 2010 to develop a telehealth platform and a support system for primary care teams with a special focus on optimizing the flow between primary and specialized levels of care. To define priorities , TelessaúdeRS analyzes the health needs of the Brazilian population and the most common inquiries it receives from primary care health professionals. This information is then combined with the best available scientific evidence for development of services. Results: Since 2010, over 50,000 clinical consultations have been provided. More than 15,000 health-care professionals have benefited from teleconsultations and from telediagnosis and tele-education activities. All services were provided using information technology solutions developed by the Telessaúde team, including smartphone apps and a Web-based National Telehealth Platform. Conclusions: The case of TelessaúdeRS/UFRGS shows that even in the presence of structural limitations, telemedicine is potentially useful to

Telemedicine in Brazil: Teleconsultations at the Largest University Hospital in the Country

Telemedicine Reports

The coronavirus disease (COVID-19) pandemic leveraged telemedicine worldwide mainly due to the need for social distancing, patient safety, and infection prevention. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) was a key reference site in the treatment of COVID-19 severe cases in the country. To continue patient's health care, it became necessary to increase the number of teleconsultations and standardize it institutionally. Herein, we briefly described how the HCFMUSP improved the teleconsultation health care service during the COVID-19 pandemic, highlighting the implementation of important innovations and the throughout standardization process, including patients and professional workflow. We also detailed the methodology used to implement or improve teleconsultation in a medical/multidisciplinary specialty at HCFMUSP. All these efforts made the HCFMUSP reach the goal of converting 15% of all face-to-face consultations into teleconsultations only in 2021. In addition, there were more than 370,000 teleconsultations until the end of 2022. Our experience has shown that having a supporting team, a digital certification process, and the data integration were key factors toward the successful implementation of the teleconsultation services. We believe that progressing toward teleconsultation will improve the population covered by health care services in Brazil, as well as contribute to a reduction of waiting time, and solving costs to health care institutions and patients. We expect this report of our experience in teleconsultation implementation could inspire and guide other health care institutions in the development of telemedicine.

Brazilian Medical Survey on Telemedicine since the onset of COVID-19

einstein (São Paulo), 2023

Objective: The primary aim of this study was to understand the difference in the use of Telemedicine by Brazilian physicians before and after the onset of COVID-19 pandemic and their intention to continue using it post the pandemic period. The secondary objective was to analyze the differences of opinion between physicians in the private and public sectors. Methods: We conducted an online medical survey through the SurveyMonkey platform in a large hospital in São Paulo, Brazil, from May to July 2022. Results: Three-hundred-and -two physicians responded to the survey. We found that there was a significant increase in the number of physicians who started using Telemedicine in both the public and private sectors (p<0.0001) since the onset of COVID-19 pandemic and that >50% of them intend to continue using Telemedicine in their daily practice. Most responders consider that Telemedicine is useful in screening, diagnosis and management of patients; that it facilitates the physician’s daily practice; that it can maintain or even add financial gains through reducing office expenses; and that is another medium for dispensing medical care. They also believe that Telemedicine should be regulated by the Brazilian Federal Council of Medicine. There were no significant differences between the responses from private and public sector physicians. Conclusion: Telemedicine has played a major role in healthcare since the onset of COVID-19 pandemic and most of the physicians approve its use and intend to continue using Telemedicine in their daily practice.

The telehealth Brasil networks: A "socially engaged" technological system

Introduction: The reflection on the "socially mediated" character of technological devices is a classic theme of Science and Technology Studies (STS). Obejctive: Evaluate the socially engaged character of the Telehealth Brasil Redes project implemented in Brazil. Method: A favorable opportunity to reconcile the STS perspective with a broader view in the scope of research on the forms of territorial displacement of health care processes is the case of Telehealth Brazil Networks. Results: Its characteristics narrow the relationship between the network design and Unified Health System (UHS) purposes, offering useful elements to a theoretical-conceptual reading of the implanted service structure. In contrast to the telemedicine standard, the service of Telehealth Networks Brazil advances beyond the classic scheme of "social mediation" of technological artifacts, aiming to expand access to health care services guaranteed public health system, a factor that democratizes and reduces inequalities among system users. Conclusion: In addition, by proposing a connection between the different health professionals, Telehealth Networks operates beyond the "local medical ecology", valuing the importance of social relations between the family health teams and the communities served.

The Telehealth Brazil Networks: a socially-engaged technological system

2019

Improving patient access to specialized health care: the Telehealth Network of Minas Gerais, Brazil

Bulletin of the World Health Organization, 2012

Brazil is a vast country of marked cultural, economic, geographic and infrastructural contrasts. It is composed of 27 federative units: 26 states and one federal district that contains the capital, Brasilia. Although the Brazilian Constitution guarantees universal and equitable access to high-quality health care, these contrasts make such access difficult to provide. Primary care is central to Brazil's public health system, which aims to provide comprehensive health care, specialized services and hospital care, as well as health promotion and disease prevention activities. 1 Minas Gerais, a large state, has 19 million inhabitants unevenly distributed among 853 municipalities and is characterized by inequities in health care. 2 Problem Residents of small and remote municipalities have difficulty accessing specialized care because health resources are concentrated in the largest cities. Health professionals in remote areas tend to be young and inexperienced and are often isolated and in need of further training. The resulting high turnover rates in the primary care workforce compromise service quality. This, plus the small amount invested in linking primary care with other levels of care and the failure to provide good access to diagnostic tests, prevents the Brazilian primary health-care model from fully meeting its objectives. 1 Telehealth, or the use of information technologies in the health professions to provide care, impart education or conduct research, has the potential to reduce existing health-care inequities by supporting primary care professionals in remote areas. 2-4 Telehealth offers an effective means of improving communication between primary care practitioners and specialists in reference centres, facilitating access to diagnostic tests and enhancing health care quality in under-served communities. 2,5 However, little information is available with respect to cost-effectiveness, access to services, process of care and user satisfaction in connection with telehealth. 5 Approach Programme development In 2005, the State Government of Minas Gerais, Brazil, funded the establishment of the Telehealth Network, designed to connect the teaching hospitals of five public universities with municipal health departments. 6 The health department Problem The Brazilian population lacks equitable access to specialized health care and diagnostic tests, especially in remote municipalities, where health professionals often feel isolated and staff turnover is high. Telehealth has the potential to improve patients' access to specialized health care, but little is known about it in terms of cost-effectiveness, access to services or user satisfaction. Approach In 2005, the State Government of Minas Gerais, Brazil, funded the establishment of the Telehealth Network, intended to connect university hospitals with the state's remote municipal health departments; support professionals in providing tele-assistance; and perform tele-electrocardiography and teleconsultations. The network uses low-cost equipment and has employed various strategies to overcome the barriers to telehealth use. Local setting The Telehealth Network connects specialists in state university hospitals with primary health-care professionals in 608 municipalities of the large state of Minas Gerais, many of them in remote areas. Relevant changes From June 2006 to October 2011, 782 773 electrocardiograms and 30 883 teleconsultations were performed through the network, and 6000 health professionals were trained in its use. Most of these professionals (97%) were satisfied with the system, which was cost-effective, economically viable and averted 81% of potential case referrals to distant centres. Lessons learnt To succeed, a telehealth service must be part of a collaborative network, meet the real needs of local health professionals, use simple technology and have at least some face-to-face components. If applied to health problems for which care is in high demand, this type of service can be economically viable and can help to improve patient access to specialized health care.

Three decades of telemedicine in Brazil: Mapping the regulatory framework from 1990 to 2018 (original) (raw)

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