1. Alexandra Monteiro. MD.PhD. Member of Brazilian Committee of Telehealth. MINISTRY OF HEALTH. Coordinator of Teleradiology Committee. BRAZILIAN COLLEGE OF RADIOLOGY. Adjunct Professor of Radiology and Coordinator of the Telehealth Center STATE UNIVERSITY OF RIO DE JANEIRO (UERJ). e-mail: alexandra@uerj.br alexandra@uerj.br Telehealth and Teleradiology BRAZIL

2. BRAZIL BRAZIL is a continental country with assimetric geographic distribution of the municipalities Brazil is a federal republic: - formed by a Federal District, 26 States and 5564 Municipalities; - with a population of over 190 million people; - 83% of the population lives in urban areas. - Human Development Index (HDI) of 0.80

3. Brazilian Health System The Unified Health System (SUS) is exclusively responsible for providing health care to 78.8% of Brazilian population, and it is the primary network of public health institutions that provide, support, and manage health services; The remaining 21.2% of the population, which are covered by the Supplementary System, is also entitled to access the health services provided by SUS; In addition to these functions, SUS is also responsible for health surveillance, disease control, and regulation of the health sector. Brazil’s challenges Support for the political and technical processes needed to ensure the country achieving the Millennium Development Goals (MDGs); Support and improvement ongoing federal projects in telemedicine and telehealth Support and improvement ongoing federal projects in telemedicine and telehealth.

4. municipalities Ministry of Communication, 2006 Brazil: Distribution of large bandwidth Brazil has a fairly advanced (but poorly distributed) ICT infrastructure, largely a result of the telecommunications privatisation process started in 1998

5. Improvements in large bandwidth Implementation of DEDICATED NETWORKS to: research, education and e-health services. Funded by the Ministry of Science and Technology Brazilian National Research and Education Network (RNP) IPÊ national backbone

6. Brazilian RNP provide national with international connections in dedicated networks to research, education and e-health services

7. Ongoing national e-health projects: RUTE (Telemedicine University Network): around all the Brazilian states. connecting the University Hospitals around all the Brazilian states. RUTE SIGs: pediatric radiology, neuroradiology, thoracic radioloy, abdominal radiology, education in radiology and technologies researchs for teleradiology. Brazilian Telehealth Program including teleradiology municipalities, Brazilian Telehealth Program*: connecting University Hospitals in 9 states to provide e-education and teleconsultation (including teleradiology) for primary health professionals in the municipalities, that covers almost 11 million people.

8. Brazilian College of Radiology (CBR) Distribution of radiologists (2010) n= 82 230 n= 5.209 28 5 31 2 88 134 89 47 480 50 42 47 134 257 695 21 4 8 354 192 23 2000 9 46 50 190 Rio de Janeiro

9. CBR-Teleradiology Committee Goals Ethical Standards in Teleradiology: Federal Council of Medicine (CFM) Resolution in Teleradiology (2009) - Federal Council of Medicine (CFM) - only physicians would ask for second opinion, - general physicians would ask teleconsultation only for general X-Ray, - radiologists from anywhere would ask for teleconsultation, - Teleradiologists may attend teleconsultation only for two states in Brazil (Federal Council of Medicine) Integration among radiologists (teleducation) DICOM protocols: CBR, Brazilian Standards Association (ABNT), Federal Council of Medicine (CFM) and Brazilian Health Informatics Society (SBIS) DICOM legislation- National Agency of Sanitary Vigilance (ANVISA) Interamerican College of Radiology (CIR) Brazilian Teleradiology Committee has been contributing to CIR Ethical Standards in Teleradiology; Ethics legislation were approved in october 2010.

10. Distribution of digital radiology equipment CT 531 19,1% MRI12112,4% CT1.46152,5% MRI54956,3% CT45316,3% MRI17718,2% CT2248,0% MRI798,1% CT1144,1% MRI495,0% Brazilian Registry of Health Facilities (CNES)

11. Partnerships: CFM - Federal Council of Medicine DATASUS - Department of Health Informatics and Information ANS - National Agency for Supplementary Health ABNT - Brazilian Association of Technical Standards ISO TC215 Mirror Committee – International Organization for Standardization HL7 Brazil- Brazilian Affiliate to Health Level Seven Organization IMIA-LAC- Latin American and Caribbean Federation of Health Informatics IMIA- International Medical Informatics Association Goals: - Stimulate educational activities related to Health Informatics (HI); - Stimulate scientific research and technical development in HI; - Contribute to the definition of health and health care policies; - Promote HI as a means to reduce costs and improve the quality of health services. Brazilian Health Informatics Association

12. Brazilian Standards Association ISO 13131 QUALITY CRITERIA FOR TELEHEALTH STANDARDS FOR TELEHEALTH: The Brazilian Standards Association (ABNT) has worked towards adopting and developing standards to support TeleHealth; Quality Criteria for Services and Systems for TeleHealth One of the most important standards in discussion in the ISO world now, is the ISO 13131 – Quality Criteria for Services and Systems for TeleHealth. The standard is in the “Committee Draft” stage, which means it still can get plenty of contribution from members; DICOM is part of the Joint Initiative Council which means that DICOM members can take part in ISO meetings. www.abnt.org.br

13. Welcome to Brazil: a virtual tour to the various regions!!!