Telecare in the Brazilian Unified Health System: where we are and where we are heading

Catapan, Soraia de Camargo; Melo, Eduardo Alves; Silva, Angélica Baptista; Albuquerque, Mariana Vercesi de; Calvo, Maria Cristina Marino

doi:10.1590/1413-81232024297.03302024EN

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OPINION ARTICLE • Ciênc. saúde coletiva 29 (7) • July 2024 • https://doi.org/10.1590/1413-81232024297.03302024EN copy

Telecare in the Brazilian Unified Health System: where we are and where we are heading

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article explores telecare from telehealth developments and the recent acceleration of the digital health transformation caused by the COVID-19 pandemic, focusing on the Brazilian Unified Health System (SUS). It addresses terminological issues, the scope of actions, the potential use for healthcare, and constraints and contingencies for telecare in Brazil, focusing on teleconsultations and interactions between health professionals and patients. Finally, it presents a set of propositions for the development of telecare policies and practices in Brazil, considering SUS principles, in two central themes: organizational political guidelines and operational propositions to organise services and healthcare delivery. The importance of clarifying the scope and limits of new technologies is highlighted in the attempt to avoid idealizations with proposed solutions to complex health problems. Telecare solutions should be compatible with SUS principles and with the recommended model of care, with the healthcare network coordinated and organised by primary care, ensuring access to health services and integrated and quality healthcare for the Brazilian society.

Key words:
Remote consultation; Telehealth; Digital health; Patient care; Unified Health System

Services	Interacting subjects	Means of communication	Synchronicity	Exemples
Telescreening or reception of spontaneous demand mediated by ICT	Health Professional ↕ Patient (individual or in group)	Telephone, video, e-mail, instant messages or specific platforms	Synchronous Asynchronous	First contact of care and referral to PHC or emergency department services
Teleconsultation	Health Professional ↕ Patient	Telephone, e-mail, chat, video	Synchronous Asynchronous	Mobile applications for teleconsultations
Teleinterconsultation or shared consultation	Health Professional(s) ↕ Health Professional(s) (with or without the presence of the patient)	Telephone, video	Synchronous	Remote guided ultrasound, multidisciplinary care
Telesurgery	Médico executor Cirurgião remoto Equipamento robótico ↕ Cirurgião local para manipulação instrumental ↕ Patient	Secure interactive technologies	Synchronous	Robot for minimally invasive surgery
Telemonitoring or Remote Patient Monitoring	Sensor (Patient) ↕ Dispositivo de coleta, transmissão, processo, manejo e armazenamento ↕ Profissional de saúde	Collection aggregated or implantable sensors (gadgets or wearables) or data reported by the patient or health professionals	Synchronous Asynchronous	Implanted cardiac devices, glucometers, or smartwatches monitored by the healthcare team, sometimes integrated to a mobile phone app via Bluetooth and shared via web based dashboard
Teleorientation	Health Professional ↕ Patient (individual or in group)	Web conferencing or instant messaging platforms with guidance that does not characterize teleconsultation (without questions about symptoms, treatments and lifestyle habits)	Synchronous Asynchronous	Health promotion activities (breastfeeding, smo of tobacco use, mental health, etc.)
Robotic call center	Inteligência artificial ↕ Patient (individual or in group)	Telephone, video, text message and robots	Synchronous	Chatbots Robots in hospitals

Organizational and policy guidelines
Infrastructure • Guarantee stable internet network and access to adequate equipment • Health systems integration and interoperability • Regulation of the incorporation of technologies into service provision • Offer, use and supervise digital health tools, public platforms and collaborative communities in line with the LGPD (data security)
Work management • Increase digital literacy (population, healthcare professionals and managers) • Develop policies for people working from home • Inclusion of digital health and telecare subjects in the curriculum of healthcare courses • Education and professional development for health professionals in how to use digital technologies for healthcare
Financial resources • Tripartite responsibility for funding actions and services (from federal, state and local level government) • Inclusion of telecare in the scope of services offered by PHC and specialized care • Promote research, development, innovation, mapping and supervision of telecare services
Consumer and community engagement • Consumer and community engagement in defining coordination and public regulation of healthcare networks • Social participation to ensure universal and equitable access to services
Operational and organization proposals for clinical workflows and healthcare services
• Adequacy of telecare services to SUS principles and guidelines • Inclusion of telecare into clinical workflows coordinated by PHC networks • Respect local and regional context particularities • Inclusion of healthcare professionals from local and regional networks in telecare • Regional digital inclusion promotion actions • Adequacy of the use of digital health tools to the needs • Rational and adequate implementation of telecare services • Expansion of healthcare services scale • Analysis of the impact of telecare for restructuring healthcare in terms of productivity • Ensure SUS quality telecare services for the population

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva