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I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
I carnegie ago 2010v2
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I carnegie ago 2010v2

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Presentation Brazilian Telehealth Program made for ICarnegie at the MOH …

Presentation Brazilian Telehealth Program made for ICarnegie at the MOH
August 2010

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  • 1. Brazil Telehealth
  • 2.  
  • 3. 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
  • 4. Brazilian Health System - SUS (Sistema Unico de Sa úde) <ul><li>National Constitution of 1988 dictates that health is a right, and it is the government’s duty to ensure it. </li></ul><ul><li>The Unified Health System has the following principles: </li></ul><ul><ul><li>Universal Care </li></ul></ul><ul><ul><li>Equitable Care </li></ul></ul><ul><ul><li>Comprehensive Care </li></ul></ul><ul><ul><li>Unified Care </li></ul></ul><ul><ul><li>Regionalized Services Network </li></ul></ul><ul><ul><li>Social Participation </li></ul></ul>
  • 5. Primary Health Care <ul><li>Brazilian Family Health Strategy </li></ul><ul><ul><li>started in 1994 </li></ul></ul><ul><ul><li>Family health team (FHT): 1 Medical Doctor (MD), 1 Registered Nurse (RN), 1 Dentist </li></ul></ul><ul><ul><li>2 technical-degree nurses and 4 to 6 Community Health Workers </li></ul></ul><ul><ul><li>30.000 FHT covering 90 million people in 60% of the Brazilian municipalities </li></ul></ul><ul><ul><li>major impact in the reduction of children mortality in the last decade ( temos os dados? ) </li></ul></ul>
  • 6. Family Health Strategy 1998 5% coverage FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind
  • 7. Family Health Strategy 2009 90% coverage FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind
  • 8. Brazilian Telehealth Strategy Brazil Telehealth Program - remote assistance and permanent education Pilot Project: 9 states and 900 points www.telessaudebrasil.org.br Open University of Unified Health System - provides in-service training for thousands of health care providers www.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
  • 9. Brazilian Telehealth Program <ul><li>Pilot project to support primaru care activities </li></ul><ul><li>Objectives: </li></ul><ul><li>Improve Primary Care quality </li></ul><ul><li>Prepare FHT workers </li></ul><ul><li>Integrate academic institutions and Primary Care Providers </li></ul><ul><li>Promote distance education (e-education) </li></ul><ul><li>Structure an e-consultation and a Second Opinion </li></ul><ul><li>Create a Virtual Library for Primary Care (BVS-APS) </li></ul>
  • 10. Brazil Telehealth Program Coverage: 9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants
  • 11. Brazil Telehealth Program 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:
  • 12. Brazil Telehealth Program <ul><li>Inclusion Criteria: </li></ul><ul><li>Municipalities with geographic access barriers; </li></ul><ul><li>Municipalities with population less or equal to 100,000 inhabitants; </li></ul><ul><li>Municipalities with FHS coverage equal or bigger than 50%; </li></ul><ul><li>Municipalities with Human Development Index less than 0,500 (low human development) </li></ul><ul><li>Distribution: 80% of the points in rural areas </li></ul>
  • 13. Brazil Telehealth Program <ul><li>Participant Institutions: </li></ul><ul><li>Ministry of Health </li></ul><ul><li>Ministry of Education (MEC) </li></ul><ul><li>Ministry of Science and Technology </li></ul><ul><li>Ministry of Defense </li></ul><ul><li>Ministry of Communications </li></ul><ul><li>Department of State - Federal Government </li></ul><ul><li>Bireme/PAHO/WHO </li></ul><ul><li>Brazilian Community and Family Health Society </li></ul>
  • 14. Brazil Telehealth Program <ul><li>Participant Institutions: </li></ul><ul><li>USP - University of São Paulo </li></ul><ul><li>UFMG - University of Minas Gerais </li></ul><ul><li>UERJ - University of Rio de Janeiro </li></ul><ul><li>UFCE - Federal University of Ceará </li></ul><ul><li>UFAM/UEA - Federal and State Universities of Amazonas </li></ul><ul><li>UFRGS - Federal University of Rio Grande do Sul </li></ul><ul><li>UFPE - Federal University of Pernambuco </li></ul><ul><li>UFG - Federal University of Goiás </li></ul><ul><li>UFSC - Federal University of Santa Catarina </li></ul>
  • 15. Number of State Centers Total: 1209 points (Primary Health Care Units) AM 42 CE 102 GO 151 MG 132 PE 99 RJ 105 RS 199 SC 160 SP 219
  • 16. Brazilian Telehealth Figures
  • 17. www.telessaudebrasil.org.br <ul><li>Health Virtual Library in Primary Health Care: </li></ul><ul><li>supports teleassistance and continuous education; </li></ul><ul><li>  access to best evidences in Primary Health Care and Telehealth; </li></ul><ul><li>decision support through the Formative Second Opinion </li></ul>2008-2009 13,000 accesses/month
  • 18. Portaria GM/MS # 402 February 2010 <ul><ul><li>National Comittee: DEGES/SGTES/MS </li></ul></ul><ul><ul><li>State Comitee – ( SES, CIES, COSEMS, Center Coordinator and ETSUS Director) </li></ul></ul><ul><ul><li>University Center </li></ul></ul><ul><ul><li>Point of Telehealth </li></ul></ul><ul><ul><li>Advanced Point of Telehealth (ETSUS, RNP, PET Salud) </li></ul></ul>
  • 19. Professional Councils <ul><ul><li>Federal Medical Council </li></ul></ul><ul><ul><li>Federal Nursing Council </li></ul></ul><ul><ul><li>Federal Dentistry Council </li></ul></ul>
  • 20. Health Ministry investments in Telehealth 1º Phase 2007 – 2008 2º Phase 2009 – 2010 R$ 14.831.778,35 US$ 7 M R$ 21.830.720,00 US$ 11 M Total: R$ 36.662.498,35 (±US$ 18,400,000)
  • 21. Implementation A Telehealth Center R$ 200.000,00 ( (± US$100,000) A Telehealth point of care R$ 2.800,00 (± US$1,400)
  • 22. <ul><li>Important factors : </li></ul><ul><ul><ul><li>Center infrastructure </li></ul></ul></ul><ul><ul><ul><li>Human Resources – Coordination Team </li></ul></ul></ul><ul><ul><ul><li>Formative Second Opinion costs </li></ul></ul></ul>Implementation
  • 23. Maintenance costs Maintenance of teleconsultants of a center/month for 100 points of Telehealth R$ 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)
  • 24. Costs reduction <ul><li>Evaluation of 33 pilot municipalities at North and Northeast of Minas Gerais : </li></ul><ul><ul><li>Referral costs in Primary Health Care were 8x more expensive when compared to the Second Opinion offered by TeleHealth . </li></ul></ul><ul><ul><li>The economy was about 5 referrals/municipalities/month or 1,5% of referrals were avoided: it’s enough to cover telehealth activities </li></ul></ul>
  • 25. 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 Important 67% Medium 27% Low importance 2% No important 4%
  • 26. Rio Grande do Sul Patient Referral (December 2007 – September 2009) Avoided 70% It was not avoided for other reasons 2% didn’t know 1% Referral required 3% Referral decided after teleconsultation 14%
  • 27. Standards National Policy of Standards for Informatics in Health and Telehealth <ul><li>PNIIS – National Policy of Health Information and Informatics – 2004 National Council of Health </li></ul><ul><li>Portaria GM/MS # 402 February 2010 </li></ul>
  • 28. HI Standards in Brazil <ul><li>Unique identifiers: </li></ul><ul><ul><li>for persons (190 M in the national database) </li></ul></ul><ul><ul><li>HC providers </li></ul></ul><ul><ul><li>HC professionals </li></ul></ul><ul><ul><li>ICD 10 since 1988 </li></ul></ul><ul><ul><li>Electronic exchange of billing between HC providers and payers for the private system (mandatory since 2207) </li></ul></ul><ul><ul><li>Software certification process Brazilian Health Informatics Association + Federal Medical Council for EHR systems ( 9 systems certified) </li></ul></ul>
  • 29. Healthcare Challenges in Brazil <ul><li>Increasing demand for health care (aging, emerging of new diseases, re-emerging of considered overcome diseases)‏ </li></ul><ul><li>Skyrocketing healthcare costs (Health Technology)‏ </li></ul><ul><li>Inefficiency, paper base uncoordinated system, multiple formularies, poor resource allocation </li></ul><ul><li>Siloed systems - one for each health program </li></ul><ul><li>Lack of adequate information to support decision making, quality of care evaluation and to monitor disease management programs; </li></ul><ul><li>Few common health and healthcare information standards within the sector </li></ul>
  • 30. PC Health Informatics, Mirror Committee of TC 215 – Health Informatics, Brazil
  • 31. Brazilian ISO TC 25 Mirror Committee ABNT - PC Health Informatics <ul><li>ABNT </li></ul><ul><ul><li>Created in September 1940 </li></ul></ul><ul><ul><li>Represents Brazil in International SDOs </li></ul></ul><ul><ul><li>Some 120 Technical Committees and growing </li></ul></ul><ul><li>PC-Health Informatics </li></ul><ul><ul><li>Created in November 2006 </li></ul></ul><ul><ul><li>An initiative of Ministry of Health and Santa Catarina Federal University </li></ul></ul><ul><ul><li>Initial Focus on TeleHealth </li></ul></ul><ul><ul><li>Attracted people from the 20-year-old Brazilian Health Informatics Society </li></ul></ul><ul><ul><li>Became formally a Mirror Committee in March 2007 </li></ul></ul><ul><ul><li>Some 100 people working at varied levels of effort and commitment </li></ul></ul><ul><ul><li>Relies 100% on Volunteers </li></ul></ul>
  • 32. ISO TC 215 Organization
  • 33. How PC-Health Informatics Works <ul><li>Adoption of ISO TC 215 Standards </li></ul><ul><ul><li>ISO 18308 - Requirements for an Electronic Health Record Reference Architecture </li></ul></ul><ul><ul><li>ISO 20514 - Electronic Health Record Definition, Scope and Context </li></ul></ul><ul><li>Adaptation of ISO TC 215 Standards </li></ul><ul><ul><li>ISO TS 22220 Identification of Subject of Care </li></ul></ul><ul><li>Creation of new Standards based on ISO TC 215 </li></ul><ul><ul><li>NBR.. Hospital Discharge Summary Data ( under development) </li></ul></ul><ul><li>NWIP (New Work Item Proposals) </li></ul><ul><ul><li>ISO TS 14639 eHealth Architecture for Emerging and Developing Countries </li></ul></ul><ul><ul><li>ISO TS 14441 Security and privacy requirements for compliance testing of EHR systems </li></ul></ul><ul><ul><li>Telehealth Standards on quality of service </li></ul></ul>
  • 34. How PC-Health Informatics Works <ul><li>Resources </li></ul><ul><ul><li>Collaboration Tool: Livelink (ABNT/ISO) </li></ul></ul><ul><ul><ul><li>Livelink has been chosen as the formal and official communication tool </li></ul></ul></ul><ul><ul><ul><li>Our use of Livelink set up a new paradigm for ABNT </li></ul></ul></ul><ul><ul><li>Web-conferencing, for daily work* </li></ul></ul><ul><ul><ul><li>Proven to be very effective </li></ul></ul></ul><ul><ul><li>Video-conferencing joining 5 cities, for monthly Plenary Sessions** </li></ul></ul><ul><ul><ul><li>Video-Conferencing was a major innovation at ABNT </li></ul></ul></ul><ul><ul><ul><li>* , ** Unifesp – São Paulo Federal University </li></ul></ul></ul><ul><ul><ul><li>** RNP – National Research Network </li></ul></ul></ul><ul><ul><ul><li>** Datasus – National Department of Health IT Division </li></ul></ul></ul>
  • 35. Results for 2007 – 2008 <ul><li>Standards Adoption (ISO Standards Translation) </li></ul><ul><ul><li>Around 30 Standars under Study </li></ul></ul><ul><ul><li>12 being translated </li></ul></ul><ul><ul><li>02 Standards in Public Consultation </li></ul></ul><ul><ul><ul><li>ISO 13606.1 EHR Communication - Part 1: Reference Model </li></ul></ul></ul><ul><ul><ul><li>ISO 18104 Terminologia de Referência para Enfermagem </li></ul></ul></ul><ul><ul><li>05 Standards Published as NBR </li></ul></ul><ul><ul><ul><li>ISO TR 20514 Registro Eletrônico de Saúde ─ Definição, Escopo e Contexto </li></ul></ul></ul><ul><ul><ul><li>ISO TS 18308 Requisitos para uma Arquitetura do Registro Eletrônico em Saúde </li></ul></ul></ul><ul><ul><ul><li>ISO TR 17119 Framework para o Estabelecimento de Perfis em Informática em Saúde </li></ul></ul></ul><ul><ul><ul><li>ISO TS 21667 Quadro Conceitual de Indicadores de Saúde </li></ul></ul></ul><ul><ul><ul><li>ISO TS 17117 Terminologia Controlada Relacionada à Saúde – Critérios para Categorização e Avaliação de Terminologias em Saúde </li></ul></ul></ul>
  • 36. Standards Government <ul><li>Active participation on ABNT (Brazilian Association of Technical Standards) - GT2 </li></ul><ul><li>Health Education Management Department and Executive Secretary: sponsored the activities of ABNT </li></ul><ul><li>ABNT strictly follows the ISO standards </li></ul>
  • 37. National Program

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