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Secretaria de Gestão do Trabalho e da Educação na Saúde

Ministério da Saúde


Brazil Telehealth




Brazil

Population: 190,000,000

States: 26 + 1 Federal District

Municipalities: 5,563

40% in metropolitan areas

220 native ethnicities (0,2% of

the population)

185 languages




Brazilian Health System - SUS (Sistema Unico de Saúde)

National Constitution of 1988 dictates that health is a right, and it is the government’s duty to ensure it.

The Unified Health System has the following principles:

– Universal Care

– Equitable Care

– Comprehensive Care

– Unified Care

– Regionalized Services Network

– Social Participation




•

Primary Health Care

• Brazilian Family Health Strategy– started in 1994– Family health team (FHT): 1 Medical Doctor (MD), 1

Registered Nurse (RN), 1 Dentist– 2 technical-degree nurses and 4 to 6 Community

Health Workers– 30.000 FHT covering 90 million people in 60% of the

Brazilian municipalities– major impact in the reduction of children mortality in

the last decade (temos os dados? )




Family Health Strategy

1998 5% coverage

FHT/Community Workers/Oral Health

FHT/Community Workers

Community Workers

Without any kind




Family Health Strategy

FHT/Community Workers/Oral Health

FHT/Community Workers

Community Workers

Without any kind

2009 90% coverage




Brazilian Telehealth Strategy

Brazil Telehealth Program - remote assistance and permanent educationPilot Project: 9 states and 900 pointswww.telessaudebrasil.org.br

Open University of Unified Health System - provides in-service training for thousands of health care providerswww.universidadeabertadosus.org.br

Telemedicine University Network - RUTE, initially about 80 University Hospitals in collaborative research and education across all federal states – http://rute.rnp.br




Brazilian Telehealth Program

Pilot project to support primaru care activities

Objectives:

Improve Primary Care quality

Prepare FHT workers

Integrate academic institutions and Primary Care Providers

Promote distance education (e-education)

Structure an e-consultation and a Second Opinion

Create a Virtual Library for Primary Care (BVS-APS)




Brazil Telehealth Program

Coverage:

9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants





9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants

Expansion states (3 + Federal District)Priority: Northeast region and Brazilian Amazon

Coverage:





Inclusion Criteria:

Municipalities with geographic access barriers;

Municipalities with population less or equal to 100,000

inhabitants;

Municipalities with FHS coverage equal or bigger than

50%;

Municipalities with Human Development Index less

than 0,500 (low human development)

Distribution: 80% of the points in rural areas





Participant Institutions:

Ministry of Health

Ministry of Education (MEC)

Ministry of Science and Technology

Ministry of Defense

Ministry of Communications

Department of State - Federal Government

Bireme/PAHO/WHO

Brazilian Community and Family Health Society




Brazil Telehealth Program Participant Institutions:

USP - University of São Paulo

UFMG - University of Minas Gerais

UERJ - University of Rio de Janeiro

UFCE - Federal University of Ceará

UFAM/UEA - Federal and State Universities of Amazonas

UFRGS - Federal University of Rio Grande do Sul

UFPE - Federal University of Pernambuco

UFG - Federal University of Goiás

UFSC - Federal University of Santa Catarina




Number of State Centers

AM42

CE102

GO151 MG

132PE99

RJ105

RS199

SC160

SP219

Total: 1209 points (Primary Health Care Units)




Brazilian Telehealth Figures




www.telessaudebrasil.org.br

Health Virtual Library in Primary Health Care:

• supports teleassistance and continuous education;

• access to best evidences in Primary Health Care and Telehealth;

• decision support through the Formative Second Opinion

2008-200913,000

accesses/month




Portaria GM/MS # 402 February 2010

• National Comittee: DEGES/SGTES/MS

• State Comitee – (SES, CIES, COSEMS, Center Coordinator and ETSUS Director)

• University Center

• Point of Telehealth

• Advanced Point of Telehealth (ETSUS, RNP, PET Salud)




Professional Councils

• Federal Medical Council

• Federal Nursing Council

• Federal Dentistry Council




Health Ministry investments in Telehealth

1º Phase 2007 – 2008 2º Phase 2009 – 2010

R$ 14.831.778,35US$ 7 M

R$ 21.830.720,00US$ 11 M

Total: R$ 36.662.498,35 (±US$ 18,400,000)




Implementation

A Telehealth CenterR$ 200.000,00 ((±US$100,000)

A Telehealth point of careR$ 2.800,00 (±US$1,400)




Important factors:

• Center infrastructure

• Human Resources – Coordination Team

• Formative Second Opinion costs

Implementation




Maintenance costs

Maintenance of teleconsultants of a center/month for 100 points of Telehealth

R$ 31.560,00 (±US$15,500)

Maintenance costs of Human Resources by center/month for 100 points of Telehelth

R$ 29.560,00 (±US$15,000)




Costs reduction

• Evaluation of 33 pilot municipalities at North and Northeast of Minas Gerais:

– Referral costs in Primary Health Care were 8x more expensive when compared to the Second Opinion offered by TeleHealth.

– The economy was about 5 referrals/municipalities/month or 1,5% of referrals were avoided: it’s enough to cover telehealth activities




Professional Fixation

Minas Gerais – Clinical Hospital: survey with 105 professionals of PHT from 32 municipalities: 67% of the respondents felt that access to training at the workplace was a major factor in to stay in their hometowns

Important67%

Medium27%

Low importance2% No important

4%




Rio Grande do Sul

(December 2007 – September 2009)

Avoided70%

It was not avoided for other

reasons 2%

didn’t know1%

Referral required3%

Referral decided after

teleconsultation14%

Patient Referral




Standards

National Policy of Standards for Informatics in Health and Telehealth

- PNIIS – National Policy of Health Information and Informatics – 2004 National Council of Health- Portaria GM/MS # 402 February 2010




HI Standards in Brazil

• Unique identifiers:– for persons (190 M in the national database)– HC providers– HC professionals– ICD 10 since 1988 – Electronic exchange of billing between HC providers

and payers for the private system (mandatory since 2207)

– Software certification process Brazilian Health Informatics Association + Federal Medical Council for EHR systems ( 9 systems certified)




Healthcare Challenges in Brazil

• Increasing demand for health care (aging, emerging of new diseases, re-emerging of considered overcome diseases)

• Skyrocketing healthcare costs (Health Technology)• Inefficiency, paper base uncoordinated system, multiple formularies,

poor resource allocation • Siloed systems - one for each health program• Lack of adequate information to support decision making, quality of

care evaluation and to monitor disease management programs;• Few common health and healthcare information standards within

the sector




PC Health Informatics, Mirror Committee

of TC 215 – Health Informatics, Brazil




Brazilian ISO TC 25 Mirror CommitteeABNT - PC Health Informatics

• ABNT

– Created in September 1940

– Represents Brazil in International SDOs

– Some 120 Technical Committees and growing

• PC-Health Informatics

– Created in November 2006

– An initiative of Ministry of Health and Santa Catarina Federal University

– Initial Focus on TeleHealth

– Attracted people from the 20-year-old Brazilian Health Informatics Society

– Became formally a Mirror Committee in March 2007

– Some 100 people working at varied levels of effort and commitment

– Relies 100% on Volunteers




ISO TC 215 Organization




How PC-Health Informatics Works

• Adoption of ISO TC 215 Standards– ISO 18308 - Requirements for an Electronic Health Record Reference

Architecture

– ISO 20514 - Electronic Health Record Definition, Scope and Context

• Adaptation of ISO TC 215 Standards– ISO TS 22220 Identification of Subject of Care

• Creation of new Standards based on ISO TC 215

– NBR.. Hospital Discharge Summary Data ( under development)

• NWIP (New Work Item Proposals)– ISO TS 14639 eHealth Architecture for Emerging and Developing

Countries

– ISO TS 14441 Security and privacy requirements for compliance testing of EHR systems

– Telehealth Standards on quality of service




How PC-Health Informatics Works

•Resources– Collaboration Tool: Livelink (ABNT/ISO)

• Livelink has been chosen as the formal and official communication tool

• Our use of Livelink set up a new paradigm for ABNT

– Web-conferencing, for daily work*• Proven to be very effective

– Video-conferencing joining 5 cities, for monthly Plenary Sessions**• Video-Conferencing was a major innovation at ABNT

*,** Unifesp – São Paulo Federal University

** RNP – National Research Network

** Datasus – National Department of Health IT Division




Results for 2007 – 2008

•Standards Adoption (ISO Standards Translation)

– Around 30 Standars under Study

– 12 being translated

– 02 Standards in Public Consultation• ISO 13606.1 EHR Communication - Part 1: Reference Model

• ISO 18104 Terminologia de Referência para Enfermagem

– 05 Standards Published as NBR• ISO TR 20514 Registro Eletrônico de Saúde ─ Definição, Escopo e Contexto

• ISO TS 18308 Requisitos para uma Arquitetura do Registro Eletrônico em Saúde

• ISO TR 17119 Framework para o Estabelecimento de Perfis em Informática em Saúde

• ISO TS 21667 Quadro Conceitual de Indicadores de Saúde

• ISO TS 17117 Terminologia Controlada Relacionada à Saúde – Critérios para Categorização e Avaliação de Terminologias em Saúde




Government

• Active participation on ABNT (Brazilian Association of Technical Standards) - GT2

• Health Education Management Department and Executive Secretary: sponsored the activities of ABNT

• ABNT strictly follows the ISO standards

Standards




National Program

i carnegie ago 2010v2

Documents

ehealth points

points of telehealth

telehealth point of

community health workers

telehealth center r

health ministry investments

family health society

brazilian telehealth