Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

BRAZILIAN TELEHEALTH INITIATIVE

The National Telehealth Primary Care Program, initially rolled out across nine states and 900 municipalities

The Telemedicine University Network, RUTE, currently connecting 23 University Hospitals, will connect 57 across all federal states until 2009and 132, including Indigenous Health Care until 2011

Ana Estela HaddadDirector of the Department of Manegment of Health Education

Secretariat of Manegment of Health Work and Education Ministry of Health - Brazil

Luiz Ary MessinaBrazilian National Education and Research Network

Ministry of Science and Technologywww.rute.rnp.br

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

Brazilian National Education and Research Network

RedCLARA

Rede Nacional de Ensino e Pesquisa (RNP) is a not-for-profit corporation incorporated under the laws of Brazil that interconnectsover 350 education and research institutions, helping an estimated public of over a millionusers, and linking all the Brazilian regional academic networks.

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

Education and Research Community Metropolitan Area Network

A 1Gbps R&E-Ring in each of the 27 state capitals!

12 are already launched!

Belem,State of Para

Vitória,State of Espirito Santo

Manaus, State of Amazonas

Brasília

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

• Hospital São Paulo e Escola Paulista de Medicina - Unifesp, (São Paulo) • Hospital das Clínicas - FM USP, (São Paulo) • Hospital Universitário de São Paulo - USP (São Paulo)• Hospital das Clínicas da Unicamp (Campinas/SP)• Instituto Dante Pazzanese de Cardiologia (São Paulo) • Hospital Universitário Pedro Ernesto - UERJ (Rio de Janeiro) • Fundação Oswaldo Cruz, (Rio de Janeiro)• Hospital Universitário Prof. P. E. de São Thiago - UFSC (Florianópolis) • Hospital das Clínicas Prof. Arnóbio Marques - UFPE (Recife)• Hospital Universitário Walter Cantídio - UFC (Fortaleza)• Hospital da Irmandade da Santa Casa de Misericórdia, (Porto Alegre)• Hospital Universitário Getúlio Vargas - UFAM (Manaus)• Hospital das Clínicas – UFMG, (Belo Horizonte) • Hospital Universitário - UFES (Vitória)• Hospital Universitário Prof. Alberto Antunes - UFAL (Maceió)• Hospital Universitário Prof. Edgar Santos - UFBA (Salvador)• Hospital das Clínicas - UFMA (São Luís)• Hospital Universitário Lauro Wanderley -UFPB (João Pessoa)• Hospital Universitário - UFPR (Curitiba)

University and Teaching Hospitals – January 2006University and Teaching Hospitals – January 2006

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

Telehealth - Federal University of Minas Gerais - UFMG

Minas TelecardioMinas Gerais State Secretary of Health

12hours a day500 ecg/day(UFMG, UFU, UFTM, UFJF, Montes Claros)

More than 300 Municipalities

Teleconsultations

on line and off line

also in some specialties

Ministy of Health

Instituto de Psiquiatria da UFRJInstituto de Puer. e Ped. Martagão Gesteira da UFRJInstituto de Neurologia Deolindo Couto da UFRJInstituto de Doenças do Tórax da UFRJInstituto de Ginecologia da UFRJHospital Escola São Francisco de Assis da UFRJMaternidade Escola da UFRJClementino Fraga Filho da UFRJHU Antônio Pedro da UFF Gaffrée e Guinle da UNIRIOCanal Saúde (Fiocruz)HU Pedro Ernesto da UERJ

Centro Pediátrico Hosannah de Oliveira da UFBAMaternidade Climério de Oliveira da UFBAHU Prof. Edgar Santos da UFBA

Maternidade Escola Assis Chateaubriand da UFCHospital Universitário Walter Cantídio da UFC

Hospital de Clínicas da UFUHospital Escola da UFTMHospital Universitário da UFJFHospital das Clínicas da UFMG

Hospital Universitário da UFSMHU Dr. Muguel Riet Correa Júnior da FURGHospital Escola da UFPELIrmandade da Santa Casa de Misericórdia (ISCMPA)Hospital das Clínicas da URGS

Hospital Universitário na UnB

HU Maria Aparecida Pedrossian da UFMS

HU João de Barros Barreto da UFPAHU Betina Ferro de Souza da UFPA

Hospital Universitário da UFS

Hospital Universitário da UFPIHU Ana Bezerra da UFRNHospital de Pediatria da UFRN Maternidade Escola Januário Cicco da UFRNHU Onofre Lopes da UFRN

HU Alcides Carneiro da UFCGHU Lauro Wanderley da UFPB

HU Júlio Müller da UFMT

Hospital Getúlio Vargas da UFAM

Hospital das Clínicas da UFPE

HU Profº Alberto Antunes da UFAL

HU Cassiano Antônio de Moraes da UFES

Hospital das Clínicas da UnicampHospital das Clínicas da FMUSPHospital São Paulo da UnifespHospital Unimar HU de São Paulo / LSITEC da USPInstituto Dante Pazzanese

Hospital de Clínicas da UFPR

HU da UFSC

Faculdade de Medicina da UFAC

Faculdade de Medicina da UNIR

Faculdade de Medicina Veterinária da UFT

Faculdade de Medicina da UFRR

Hospital das Clínicas da UFG

Phase 1Phase 2FacultiesTelehealth Program

HU da Universidade Federal do Maranhão da UFMAFaculdade de Enfermagem da UNIFAP

List of University Hospitals – Telemedicine University Network RUTE – 2009

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

University Hospital Infr@-structure

Connection to a 1Gbps Metropolitan R&E Ring Create a Telehealth Unit with Videoconference Room,

Teleconsult, Telediagnosis Participate in Special Interest Groups Demonstrate teleassistance, teleeducation and teleresearch

23 University and Teaching Hospitals on-line broadband+ 10 August 2009+ 12 December 2009+ ca. 100 until December 2011

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

Rute phase III +75 institutions

All accredited Teaching Hospitals (60)Federal Institutions from the Ministry of HealthNational Foundation for Indigenous Health

Ministy of Health

Project RG-T1509 : eHealth Public Policies in Latin America

RedCLARA

Ministries of Health signed the commitment: Brasil, Colombia, Ecuador, México, Uruguay

Project components1. Regional Standards for transmission and infra-

estructure2. Strategy for the promotion, prevention and

assistance through telehealth3. Regional guide for telehealth managing4. Strategy for a LA Telehealth University Network5. Telehealth training and certification

Ministy of Health

Family Health StrategyPrimary Health Care in Brazil

Ministy of Health

1998 1999 2000

2001 2004

Actual % of population covered by health family teams – Brazil, 1998 –2005

0% 0 a 25% 25 a 50% 50 a 75% 75 a 100%FONTE: SIAB - Sistema de Informação da Atenção Básica

The rate of change

2008

Ministy of Health

Formative Second Opinion to Familiy

Health Teams

Promotes on-job training.

Evidence-based Health.

Adapted to regional needs, and regulated by PHC specialists

Strategy to establish a epidemiologic surveillance.

Allows the establishment of knowledge stations

Ministy of Health

Coverage:

Nine State Clusters

implementing Telehealth in

900 health units supporting

about 2.700 Health Family

teams, covering 11.000.000

inhabitants.

eHealth National Pilot Project

Ministy of Health

Espaço de registro, publicação, e acesso integrado à informação de boa evidência em APS e telessaúde, além de informação sobre o Programa Nacional de Telessaúde e a Rede Telessaúde Brasil.

www.telessaudebrasil.org.br

Ministy of Health

Deployment

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

The Terena People concentrates its communitiesIn the Pantanal Region, stateof Mato Grosso do Sul

Ministy of Health

Ministy of Health

Which activity would have the highest impact on the Primary Health Care daily routine?

4%

5%

7%

9%

9%

15%

16%

35%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Informal courses

Educational videos

Transmission of ScientificEvents

Transmission of smallsurgical

procedures/simulations

Acess to Health Virtual Library

Lectures on specific subjects

Clinic Case Discussions

Formal specialization courses Formal Training

Lectures on Special Topics

Access to the Virtual Library

Surgery / Procedure Simulation

Virtual Scientific Meetings

Discussion of Clinical Cases

Educational Videos

Informal Training / Courses

Ministy of Health

Ministy of Health

Ministy of Health

Ministy of Health

Ministy of Health

Ministy of Health

Lessons Learned

A long debate with civil society is a key step.

Social participation is essential

including teachers, students, local health system workers

and managers.

A nationwide joint effort from federal Ministries,

Agencies, Universities and civil society is required.

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

Lessons applied in Brazil

Support the Family Health ProgramConnectivity and eHealth Centers in

university and educational hospitalsImplement Telehealth procedures

(continuous education, second opinion and Teleconsult) into rural and underserved regions

International collaborationNational coordination

Ministry of Health

Ministry of Science and Technology

Ministry ofEducation

Achieved Results

Comprehension of the technological opportunity Infr@-structure in University and Educational

HospitalsAcceptance of eHealth normsStimulate academy, government and enterprisesBroaden discussion on health preventionEnable international collaboration

Ministy of Health

“The future has already arrived. It is just not equaly distributed”

Amazonia

Rio de Janeiro

São Paulo

Amazonia