BRAZILIAN TELEMEDICINE NETWORKS

Ricardo Alfredo Quintano Neira, Leandro Galassi Zavitoski, Paulo Roberto de Lima Lopes

Henrique Manuel Lederman, Paulo Schor, Ivan Torres Pisa and Daniel Sigulem

Medical Informatics Department, Federal University of São Paulo (UNIFESP), Rua Botucatu 862, São Paulo, Brazil

Keywords: Telemedicine, Networks, Public Health.

Abstract: One of the outcomes of the telemedicine evolution was the emergence of telemedicine networks which can

be characterized as the interconnection of centres or healthcare professionals to provide telemedicine

services. This paper aims to present a study of the characteristics of the Brazilian telemedicine networks.

For the implementation of this study and the selection of the projects, the authors proceeded a search and

revision of articles and sites obtained in the Google and PubMed repositories. As conclusion, the existence

of two types of networks was verified: infra-structure and telemedicine service; all of the networks are

based on asynchronous telemedicine, most of them acting in inter-cities, nevertheless there are not

telemedicine cases inside the own municipal district to eliminate socioeconomic barriers; there were not

find inside these networks projects or initiatives to regulate the remuneration of the professionals involved

in the processes as well as, the payment for the services that were used.

1 INTRODUCTION

Telemedicine is defined as the offer of services

related to health care, as well as the changing of

information in cases where the distance is a critical

factor (Neira, 2006). These services are provided by

health professionals, using information and

communication technologies for exchanging valid

information for diagnoses, and for the health care

providers continuous education, as well as, for

research and evaluations purposes.

Actions in telemedicine are being done in Brazil

since the 90’s decade, and although the efforts

demonstrate exciting potential results and the great

medical centers possess plenty of advanced hospital

units, it persists a growing demand for medical care

in remote places, executed by skilled professionals

and, in this way, initiatives and projects appeared in

telemedicine (Rede Nacional de Ensino e Pesquisa,

2006).

Among these projects we can observe the

telemedicine networks implementation which can be

characterized as the interconnection of health

professionals, universities, diagnoses centers,

libraries, hospitals, as well as government entities.

These networks intend to eliminate the physical and

social barriers to the healthcare services. Their

objectives are (Anderson, 2006): 1) improve access

to the specialists' services; 2) allow the patients'

attendance minimizing displacements; 3) improve

teaching and updating in medicine and health.

The objective of this article is to present a study

and analysis of the characteristics of the Brazilian

telemedicine networks.

2 MATERIALS AND METHODS

To start this work, first of all we collected

information from Annals of Brazilian Health

Informatics Congresses from 2006. As well as, we

have collected more information by contacting local

authorities, national administration and other

informal sources of information, like websites,

newspaper and magazines.

For this formal study we have selected

telemedicine network projects considering papers by

systematic review from PubMed (PubMed Central,

2007) and systematic search in Google (Google,

2007). With the objective to use the specific

descriptors for the searches above, first it was done a

review on DeCS - Health Sciences Descriptors

(Descritores em Ciências da Saúde, 2007) – a Latin

235

Alfredo Quintano Neira R., Galassi Zavitoski L., Roberto de Lima Lopes P., Manuel Lederman H., Schor P., Torres Pisa I. and Sigulem D. (2008).

BRAZILIAN TELEMEDICINE NETWORKS.

In Proceedings of the First International Conference on Health Informatics, pages 235-238

 SciTePress

American version of MeSH – to identify keywords

for the search. Only the term telemedicina

(telemedicine) was found. Although we didn't find a

representing term for telemedicine networks, the

following terms were adopted for this research: rede

telemedicina (telemedicine network) and rede

telemedicina Brasil (telemedicine network Brazil).

Then, on February 2007, we searched on Google

(Google, 2007) - with the web option selected - and

on PubMed (PubMed Central, 2007) repositories

using the identified terms described above.

2.1 Search and Inclusion Criteria

The first 20 summaries results of selected the

repositories were analyzed. When the summary

presented information about a Brazilian telemedicine

network, the article was considered for this study.

Just the articles that had objectives and goals about

Brazilian telemedicine networks were added to this

review. In those cases where article made reference

to a new telemedicine network that wasn’t found

previously it was made a new specific search. We

search that new network on same repositories

proceeding to verify the 10 first results following the

same criteria of the main search.

Due to the lack of telemedicine networks

information standardization, without any condition

to determine similar points of comparison, these

criteria were established.

3 RESULTS

The telemedicine networks found based on the

established criteria were eight. Following the results:

3.1 Academic Network of

Telemedicine – Rede Universitária

de Telemedicina (RUTE)

The RUTE objectives include to support the

improvement of existent telemedicine projects in

university hospitals and to motivate the arising of

futures inter-institutions works (

Rede Universitária de

Telemedicina, 2007).

The initiative intends to create the use of

advanced network services to promote the arising of

new applications and tools that explore innovative

mechanisms for the education in health, for distance

cooperation in pre-diagnosis and for the remote

evaluation of medical service data. (Santos, 2007).

3.2 Catarinense’s Telemedicine

Network Project - Rede Catarinense

de Telemedicina (RCTM)

It consists of an infrastructure for distributing digital

diagnosis services. Its objectives are to be used as

sample for the formulation of a new technological

model and standards that can be used by institutions

of public health in other states of Brazil.

The project includes all of the functionalities of

the assistance telemedicine, integrating on a single

on-line platform the acquisition of data or images of

exams, the dispatch of results, the request of patient

internment and the decisions to be taken. (The

Cyclops Group, Rede Catarinense de Telemedicina,

2007) (Sociedade Brasileira de Informática em

Saúde, 2007).

3.3 Medical Digital Station - Estação

Digital Médica (EDM)

The project links hospitals, universities, and other

institutions through the telecommunications,

informatics and other technological solutions.

The EDM objectives include fomenting the

practice of medical care and education in distance at

Brazil, optimizing the health system. Its actions,

among others, include programs of professional

improvement, technical training, information and

prevention, second specialized medical opinion,

clinical discussions (Estação Digital Médica, 2007).

3.4 ONCONET

The ONCONET includes a network of universities,

and research medical institutions. It consists of a

system developed in a client-server model using

open software tools.

The ONCONET objective consists in supporting

the medical practice in pediatric oncology. This

project presents the electronic patient records for

child cancer, distance education, and the data mining

and statistics quantifications (Yuuji, 2005). It began

its operations in 2004. Today it has 30 hospitals

affiliated to the Brazilian Society of Pediatric

Oncology (SOBOPE - Sociedade Brasileira de

Oncologia Pediátrica).

3.5 HEALTHNET

HealthNet is a telemedicine application that

interconnects institutions between São Paulo and

Recife. More specifically, it gives support to the

remote diagnosis and to the second medical opinion.

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It is a project from NUTES (NUTES - Núcleo de

Telessaúde, 2007).

Its objectives includes to improve the health

services for distant and lacking areas, as well as to

allow implanting a medical cooperation process

among great specialist centers. (Rede Nacional de

Ensino e Pesquisa, 2007).

3.6 Telemedicine Brazilian System -

Sistema Brasileiro de Telemedicina

(SBTM)

The SBTM objectives are to include all the

functionalities of the assistance telemedicine in a

unique on-line platform. It involves the creation of a

national model of telemedicine with the definition of

a Brazilian standardization for the section and the

construction and refining a group of software

technologies model for the implantation of a public

network of telemedicine (The Cyclops Group,

Sistema Brasileiro de Telemedicina – SBTM, 2007).

3.7 T@LEMED

This network intends to demonstrate the supply of

telemedicine services in critical areas of Colombia

and Brazil. The implementation of this e-health

model is based on modern technologies of remote

health as well as on medicine based on evidences.

(Sachpazidis, 2006; Santos, 2007).

3.8 BH-Telessaúde (BHT)

Its goal consists in developing a low cost project that

solves two problems on the Unique System of

Health (SUS - Sistema Único de Saúde): physicians

and other professionals precarious formation and the

visible choke of the secondary attention. The

network is implanted in 76 basic health units (UBS –

Unidade Básica de Saúde), and focuses in the

primary attention, by offering assistance support

through second opinion, consultancy and discussion

of clinical cases, besides activities of permanent

education (Santos, 2007).

In order to facilitate the observation and the

analysis of the results of this study, Table 1 was

generated. In this way, it can be seen which

networks practice distance education, which practice

the asynchronous telemedicine, among other

characteristics. The identified items with an 'X'

indicate that the network has such characteristic;

those identified with '?' mean that there was not

found any information about the characteristic; the

lack of any identification type means that the

network does not have such characteristic.

Terms used in Table 1: Distance Education - the

telemedicine network provides the remote education

for the health professionals involved. Implanted and

Operating - the telemedicine network is firmly

established. Asynchronous Telemedicine – type of

telemedicine that not occurs in real time. That means

that the response for a request of health care occurs

later without synchronicity (Wootton, 2006).

Synchronous Telemedicine – type of telemedicine

that occurs in real time. That means that the entities

involved in the process need to be online at the same

time, with synchronicity (Wootton, 2006). Inter-

cities – the telemedicine process occurs between

different cities. Telemedicine Service - systems and

processes that promote telemedicine services. Infra-

structure Network - physical structures (equipments

and communication resources) that allow and

facilitate the use of telemedicine.

4 CONCLUSIONS

Analyzing the data presented on Table 1, it is

verified the existence of two types of networks:

infra-structure and telemedicine service. The first

one can be characterized just by network infra-

structure that allow and facilitate the use of

telemedicine. This infra-structure is represented as

LAN (Local Area Network) or WAN (Wide Area

Network) equipments and communication resources.

The second one can be characterized by systems and

processes that promote telemedicine services and

may come in computational systems format or as an

agreement between institutions. Normally, the

service networks runs over the network infra-

structure. It’s possible to verify that most of the

Brazilian networks do the service type.

It can be observed that all of the networks use the

asynchronous telemedicine and only four of them

use the synchronous form. This difference may be

justified due to the low cost and the easiness of use

that the asynchronous telemedicine proportionate

(Wootton, 2006). For example, there is no need to

schedule its use and its participants do not need to be

online at the same time.

The majority of the networks act in inter-cities.

However there are few cases of telemedicine inside

the own municipal district to eliminate

socioeconomic barriers and/or to provide safety to

the health professionals, for example, in the

BRAZILIAN TELEMEDICINE NETWORKS

237

Table 1: Main characteristics of the Brazilian telemedicine networks.

penitentiary health care. The majority part of

Brazilians perceives a 2440 dollars/year salary and

don’t have sufficient financial resources to pay the

transportation to specialized medical centers.

Finally, there were not find inside these networks

any project or initiative to regulate the remuneration

of the professionals involved in the processes as well

as, the payment for the services that were used.

Those points are important because of professionals

financial resources needs and it always exists costs

of maintenance of equipments and systems. The

outcome could be disinterest and discontinuity of

services that aim to improve the people's health and

of their communities. The cost-effectiveness of any

of the eight telemedicine solutions was not found.

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Characteristic RUTE RCTM EDM ONCONET HEALTHNET SBTM T@LEMED BHT

Distance Education X X X X ? - X

Implanted and Operating X X X - X X

Asynchronous Telemedicine X X X X X X X X

Synchronous Telemedicine X X X - X ? X X

Inter-cities

X X X X X X X X

Telemedicine Service X X X X X X X X

Infra-structure Network X X - - - - - -

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