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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)
    • 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
  • 5. 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? )
  • 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
    • 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)
  • 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
    • 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
  • 13. Brazil Telehealth Program
    • 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
  • 14. 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
  • 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
    • 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
    2008-2009 13,000 accesses/month
  • 18. 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)
  • 19. Professional Councils
      • Federal Medical Council
      • Federal Nursing Council
      • Federal Dentistry Council
  • 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$1,400)
  • 22.
    • Important factors :
        • Center infrastructure
        • Human Resources – Coordination Team
        • Formative Second Opinion costs
    Implementation
  • 23. Maintenance costs Maintenance of teleconsultants of a center/month for 100 points of Telehealth R$ 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
    • 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
  • 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
    • PNIIS – National Policy of Health Information and Informatics – 2004 National Council of Health
    • Portaria GM/MS # 402 February 2010
  • 28. 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)
  • 29. 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
  • 30. PC Health Informatics, Mirror Committee of TC 215 – Health Informatics, Brazil
  • 31. Brazilian ISO TC 25 Mirror Committee ABNT - 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
  • 32. ISO TC 215 Organization
  • 33. 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
  • 34. 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
  • 35. 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
  • 36. Standards 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
  • 37. National Program

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