Telehealth in Latin America
        and Brazil:
    Current Status and
       Perspectives
     Renato M.E. Sabbatini, PhD...
Renato M.E. Sabbatini, PhD
• Founder and president, International Center for
  Information and Communications Technologies...
Topics
•   Quick views of LA and Brazil
•   Historical evolution of telehealth
•   Recent developments
•   Telehealth part...
Why Telemedicine in LA
• Several countries with continental
  dimensions, large distances and difficult
  access to many c...
A Quick View of
 Latin America
• 33 countries
• 8.6 % of world population
  and 4 % of land area
• 520 million inhabitants...
A Quick View
    of Brazil
• Fifth largest country and
  10th largest economy in
  the world
• 8,5 million km2
• 187 milli...
A Map of Human Development
Distribution of Physicians in Brazil
• Total of 290.000 physicians
• Área of 200 km near Greater São Paulo:
  85.000 physi...
Distribution of Physicians
• Amazonas: 2,300 physicians in the state,
  but 2050 in the city of Manaus!
• More than 1,200 ...
Evolution of Telemedicine

              Increase in               Rebirth
              Applications
First Tests
        ...
Status of Development
• More developed: Mexico, Brazil,
  Argentina, Costa Rica, Cuba
• Intermediate: Colombia, Venezuela,...
HistoricalAntecedents

• 1983-1992: Development of Brazilian
  packet switching network, text
  messaging services and fil...
Recent Developments
• 1993-1996: Consolidation and expansion of digital
  infrastructure: Research Network, commercial
  I...
Telecommunications in Brazil
• 25 million fixed telephone lines
• 52 million mobile phone lines
• 32 broadcasting and tele...
Applications Funding in Brazil
• FUST: Universalization of Telecommunications
  Tax Fund: a 1% tax levied on all telecom b...
Academic Internet 2 in Brazil
Most Common Applications
USA                    Brazil
• Radiology            •   Cardiology
• Cardiology           •   Ra...
Telemonitoring: Electrocardiogram

Portable monitor

                   Stethoscope

                                 Call...
Current status in Latin America
• Great potential for expansion and universal adoption
• Still in the beginning: very few ...
Telemedicine as a Discipline

•   Appearance of R&D and training centres
•   Building of a specialized community (first
  ...
Institutional Support
• Ethical and professional regulamentation of
  telemedicine and electronic patient record
  by the ...
Technical and Scientific
          Meetings
• Brazilian Congress of Biomedical Engineering,
  since 1978
• Brazilian Congr...
Interesting Ongoing Projects
•   Telemedicine for the Family Health Programme
•   Amazon Telehealth Project (SIVAM)
•   Pe...
Rural Health Internship
Federal University of Amazonas
http://www.edumed.net/amazon
The
                                 Edumed.Net
                                 Consortium
• Satellite and videoconferenc...
National Network for     University

Distance Education                      Satélite digital
                            ...
Technologies
•   WWW
•   Tele e videoconferencing
•   On demand audio and video
•   Digital satellite TV
•   Digital libra...
Ongoing Edumed Projects
• MIDAS and EduVirt Projects
    – Wireless municipal Intranet for education and health
    – Pilo...
MIDAS and EduVirt
       Targets villages and counties
       with less than 50,000
       thousand inhabitants (90% of
  ...
DVB-RCS Satellite Connection
         TV
         Internet
Bidirectional Satellite

                                                              Remote Rooms




                  ...
Wireless Broadband Network
                           Access: Point

Access to
Internet




                              ...
19              20


                                                                             18


                   ...
Portable Telehealth
                                 Biosignal telemonitoring
                                 devices (EC...
Funções do Sistema
• Monitoração e transmissão de sinais vitais
   – ECG, temperatura, pulso, pressão sanguinea, glicemia,...
Requirements for Advancing

• Market development and maturation
   – Decentralization of hospital-based care
   – Family h...
Projects for the Future
• Multi-institutional training in telehealth, with
  international cooperation
• Development of a ...
Telehealth Sites in Brazil
• Instituto Edumed:
  www.edumed.net/
• Telemedicina: www.telemedicina.org.br
• Telesaúde: www....
Contact Information
• Renato M.E. Sabbatini
  Email: renato@sabbatini.com
  Tel. (19) 3579-1230
  Home page:
  www.sabbati...
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The Status of Telehealth in Brazil

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A review of the status of telehealth and telemedicine in South America and Brazil, presented to the Canadian Telehealth Conference, Quebec, Canada, October 2004

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The Status of Telehealth in Brazil

  1. 1. Telehealth in Latin America and Brazil: Current Status and Perspectives Renato M.E. Sabbatini, PhD UNICAMP Instituto Edumed
  2. 2. Renato M.E. Sabbatini, PhD • Founder and president, International Center for Information and Communications Technologies in Health, The Edumed Institute, Campinas, Brazil • Former director of the Center for Biomedical Informatics and chairman of Medical Informatics of the Medical School, State University of Campinas, Brazil • Former director of informatics, Brazilian Medical Association
  3. 3. Topics • Quick views of LA and Brazil • Historical evolution of telehealth • Recent developments • Telehealth particularities in Latin America • Research & development • Technical and scientific events • Examples of ongoing projects • The future of telehealth in Latin America
  4. 4. Why Telemedicine in LA • Several countries with continental dimensions, large distances and difficult access to many communities • Large areas with low populational density and poor human development • Extreme unequalities of distribution of health care resources
  5. 5. A Quick View of Latin America • 33 countries • 8.6 % of world population and 4 % of land area • 520 million inhabitants • 20 million km2 • 98% Spanish and Portuguese speaking • Large regional disparities in human development • Low priority for health and education development
  6. 6. A Quick View of Brazil • Fifth largest country and 10th largest economy in the world • 8,5 million km2 • 187 million inhabitants • Most advanced economy, health care, digital and telecommunications sectors in Latin America • 20 million Internet users
  7. 7. A Map of Human Development
  8. 8. Distribution of Physicians in Brazil • Total of 290.000 physicians • Área of 200 km near Greater São Paulo: 85.000 physicians • State of São Paulo: 100.000 physicians • 20 largest cities: 82,5% of physicians • 150 largest cities: 89% of physicians • Cities with 100 physicians or more: 260 • 11% physicians dispersed in 3050 cidades
  9. 9. Distribution of Physicians • Amazonas: 2,300 physicians in the state, but 2050 in the city of Manaus! • More than 1,200 counties have no resident physician • 112 medical schools (the majority is located in capital cities), 9.000 new physicians graduate each year, but only 25% have access to medical residence.
  10. 10. Evolution of Telemedicine Increase in Rebirth Applications First Tests Failure Self sustained Intermission projects Final 50’s Meio 70’s Início 90’s Latin America
  11. 11. Status of Development • More developed: Mexico, Brazil, Argentina, Costa Rica, Cuba • Intermediate: Colombia, Venezuela, Chile, Uruguay • Less developed: most of Central America, Caribbean, Guyanas, Paraguay, Bolivia, Peru, Ecuador
  12. 12. HistoricalAntecedents • 1983-1992: Development of Brazilian packet switching network, text messaging services and file transfer (RENPAC, BITNET) • 1985: First telemedicine projects – Store & Forward at 1.2 kbps via PSN
  13. 13. Recent Developments • 1993-1996: Consolidation and expansion of digital infrastructure: Research Network, commercial Internet, ISDN, dedicated fiber optical networks, high performance computing and networking, satellite-based communications • 1997: Privatization of telecommunications industry • 1998-2000: First hospital-based telemedicine projects • 2002-2004: First government-sponsored planning and projects
  14. 14. Telecommunications in Brazil • 25 million fixed telephone lines • 52 million mobile phone lines • 32 broadcasting and telecommunication satellites, including 3 Brazilian-owned • 4,5 million km fiber backbones • 89% cities have wired communications, but only 10% with broadband • All current technologies implemented • Strong research, development and innovation
  15. 15. Applications Funding in Brazil • FUST: Universalization of Telecommunications Tax Fund: a 1% tax levied on all telecom bills. US$ 30 million per month, US$ 900 million assets • To be applied in health, education, digital libraries, satellite-based access in remote communities, handicapped people, social assistance projects, e-government • FUNTTEL: Technological Development of Telecommunications Tax Fund: 0,5% levied on all telecom bills
  16. 16. Academic Internet 2 in Brazil
  17. 17. Most Common Applications USA Brazil • Radiology • Cardiology • Cardiology • Radiology • Dermatology • Clinical Psychology • Psychiatry • Pathology • Home care • Emergency Medicine • Pathology
  18. 18. Telemonitoring: Electrocardiogram Portable monitor Stethoscope Call center
  19. 19. Current status in Latin America • Great potential for expansion and universal adoption • Still in the beginning: very few projects, most are pilot or showcasing • Recent significant growth, both in the private and public sectors • Still no model for financing and payment of telehealth services • Countries in the region differ widely from one another • Insufficient development of telemedicine as a separate technical specialty or discipline
  20. 20. Telemedicine as a Discipline • Appearance of R&D and training centres • Building of a specialized community (first associations, conferences, publications, sites, lists) • Institutional support, first large scale projects • International cooperation projects • Training programmes for specialists • Appearance of first specialized companies in the market • Market development
  21. 21. Institutional Support • Ethical and professional regulamentation of telemedicine and electronic patient record by the Federal Council of Medicine, 2002 • Technical Chambers for telemedicine and distance education in the Federal Council of Medicine • Creation of the Health Information and Informatics Area in the Ministry of Health, 2002
  22. 22. Technical and Scientific Meetings • Brazilian Congress of Biomedical Engineering, since 1978 • Brazilian Congress of Health Informatics, since 1986 • TELMED: International Conference on Telemedicine and Distance Education, since 1999 • Others: Brazilian Computing Society, Brazilian Council of Telemedicine and Telehealth (2003), Federal Government-sponsored symposia and workshops (2004)
  23. 23. Interesting Ongoing Projects • Telemedicine for the Family Health Programme • Amazon Telehealth Project (SIVAM) • Pediatric Oncology Network • Telecardiology • International Medical Second Opinion • Teleautopsy Teaching Programme • The Edumed.net Consortium
  24. 24. Rural Health Internship Federal University of Amazonas
  25. 25. http://www.edumed.net/amazon
  26. 26. The Edumed.Net Consortium • Satellite and videoconferencing national network for distance education in health and telehealth • Consortium of 27 universitties, research centres and medical associations for generating certified quality content and services • Started on June 2000, led by the Edumed Institute, a not-for-profit institution • Targets the non-academic health sector (hospitals, government, etc.)
  27. 27. National Network for University Distance Education Satélite digital Internet and Telehealth Videoconferência University University Hospitals Health Centres Associations
  28. 28. Technologies • WWW • Tele e videoconferencing • On demand audio and video • Digital satellite TV • Digital libraries
  29. 29. Ongoing Edumed Projects • MIDAS and EduVirt Projects – Wireless municipal Intranet for education and health – Pilot project at Sobral, Northeast • Amazon Telehealth Programme – Rural Health Internship – Aboriginal Telehealth • Digital Multimedia Library (EdumedSAT) • Distance Continued Education in Health Sciences • Pediatric Oncology and Telecardiology Projects • CHUM-Edumed Case Teleconferences
  30. 30. MIDAS and EduVirt Targets villages and counties with less than 50,000 thousand inhabitants (90% of the 5.560 Brazilian counties) • Universal access to Internet • Decreasing the digital divide • Public e-libraries • Telehealth • Distance education • Satellite broadband connectivity • Wireless distribution
  31. 31. DVB-RCS Satellite Connection TV Internet
  32. 32. Bidirectional Satellite Remote Rooms switch Streaming Vídeo MPEG-2 IRD Content IP Generation Modem 360E IRD TV HUB VCR switch Streaming Vídeo MPEG-2 IRD IP Internet Modem 360E IRD TV VCR
  33. 33. Wireless Broadband Network Access: Point Access to Internet • Up to 1200 SM per AP • Up to 15 km coverage • 3,6 Mbps bandwidth Subscriber Modules
  34. 34. 19 20 18 16 15 17 01 02 03 04 07 08 05 11 10 06 13 09 12 Acesso a Internet via 14 Telemar
  35. 35. Portable Telehealth Biosignal telemonitoring devices (ECG, spirometry, stethoscope, etc.) Glucometer, thermometer, pulse oxymeter PDA Teleconference software Internet-enabled mobile or satellite phone Wireless network enabled Satellite VSAT modem Simulated product
  36. 36. Funções do Sistema • Monitoração e transmissão de sinais vitais – ECG, temperatura, pulso, pressão sanguinea, glicemia, sons cardíacos e pulmonares, pCO2, pO2, fluxo e volumes respiratórios, etc. • Via modulação sonora ou comunicação de dados • Transmissão de imagens • Pele, face, olhos, boca, eventos traumáticos, etc • Teleconsulta e segunda opinião • Voz via celular • Text via SMS, WAP e Internet
  37. 37. Requirements for Advancing • Market development and maturation – Decentralization of hospital-based care – Family health, increase in coverage • Development of specific culture and acceptability • Increase in technology transfer, offer, local expertise and manpower • Large pilot projects with self-sustainability horizon • Consolidation of a suitable economic model
  38. 38. Projects for the Future • Multi-institutional training in telehealth, with international cooperation • Development of a low-cost videoconferencing terminal and telehealth peripherals • Massive expansion through federal and international funding • Integration of telehealth to primary and family care • Regulatory alliance • Extensive use of standards • Enterprise-public-academic alliance
  39. 39. Telehealth Sites in Brazil • Instituto Edumed: www.edumed.net/ • Telemedicina: www.telemedicina.org.br • Telesaúde: www.telesaude.org.br • Edumed Newsletter: www.yahoogroups.com/group/edumednewsletter • Telemedicine Newsletter www.yahoogroups.com/group/telemednewsletter
  40. 40. Contact Information • Renato M.E. Sabbatini Email: renato@sabbatini.com Tel. (19) 3579-1230 Home page: www.sabbatini.com/renato

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