The case of TelessaúdeRS/UFRGS shows that even in the presence of structural limitations, telemedicine is potentially useful to improve the quality of care and streamline the flow between different levels of care.

Novos desafios epidemiológicos e demográficos demandam novas formas de organizar os sistemas de saúde. O presente ensaio propõe a telessaúde como ferramenta organizativa, capaz de suavizar o triângulo de ferro da atenção à saúde e de facilitar a busca pelo triple aim, pelo seu potencial de aumento do acesso e qualidade com redução de custo. A integração da telessaúde ao processo de referência e transição entre serviços assistenciais aumenta a resolutividade da Atenção Primária à Saúde (APS), favorece a coordenação do cuidado, promove adesão terapêutica, diminui reinternações e estimula a prevenção quaternária. Este ensaio propõe a telessaúde como metasserviço que confere densidade tecnológica à APS e permite que ela se torne coordenadora efetiva do cuidado, passando a organizar o fluxo de informações, pessoas e insumos. Frente às inovações propostas, é essencial avaliar o impacto de ações já existentes de telessaúde para viabilizar a sua aplicação como metasserviço de saúde.

To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. Methods We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. Results Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged �65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001).

Our challenge was to structure a telemedicine framework that is capable of expanding access to services and testing while increasing the quality of the services provided. In this report, we describe the development of a telemedicine project in Brazil and its impact on increasing access to specialist consultations, diagnostic testing, and specialized medical advice to physicians. WHO & WHEREIn early By December, 2016, more than 83,000 hotline teleconsultations had been provided, with user satisfaction rates close to 95%. Specialist consultation was rendered unnecessary in 2 out of every 3 cases discussed.The state of Rio Grande do Sul struggles with large waiting lists in various medical specialties. The wait time can in many cases exceed 3 years. We worked with the Rio Grande do Sul State Department of Health to improve the quality of specialist referrals through development of referral protocols and clinical discussion of waitlisted patients. This has been implemented for 13 medical specialties, with protocols developed for 147 health conditions. As a result, the backlog of specialty appointments was reduced from 190,000 to 68,000 in just 2 years (July 2014 to Dec 2016). We had no problem adding specialists because we created a new field of work for them within the project.We have also expanded our portfolio with telediagnosis and tele-education initiatives. Tele-education actions include the provision of health apps (230,000 downloads so far), distance learning (15,000 students), a YouTube channel, (more than 1 million views) and a website where all our services are centralized. In 2013, we added a telespirometry service, which has already provided 13,000 tests using 9 spirometers distributed across the state of Rio Grande do Sul, enough to cover 100% of the state population of 11 million. This alone has sharply reduced wait times for pulmonary medicine consults (See the Supplemental Appendix).Brazil's medical residency programs are expected to encourage residents to use our tools, which are also promoted through contact with coordinators and presentations at national congresses. In our university, all 140 medical students in their final year are required to make at least 2 teleconsultations in the 3 months of internship. LEARNINGThrough this project, we have learned that effective information and communication technologies can be extremely valuable in health care. Telehealth represents the future of primary health care, and there is no way back.

a Teleconsultation: new frontier of the interaction between doctors and patients A teleconsulta, uma ação de telessaúde, apesar de ser regulamentada em vários países, ainda não é permitida no Brasil. O presente texto explora a situação da teleconsulta na América do Norte, na Europa e em outros países, fazendo um paralelo com a situação nacional dentro da medicina e de outras profissões da saúde. Ao final, por meio do referencial utilizado, é construída uma argumentação de forma a assumir um posicionamento favorável à regulamentação da teleconsulta no país. declaram não haver. ResumoParecer CEP:não se aplica. Conflito de interesses:declaram não haver. La teleconsulta, una acción de telesalud, a pesar de ser regulada en varios países, todavía no es permitida en Brasil. El presente texto explora el tema de la teleconsulta en América del Norte, en Europa y en otros países, haciendo un paralelo con la realidad nacional en la medicina y otras profesiones de la salud. Finalmente, a partir del marco teórico analizado, se construye una argumentación para asumir un posicionamiento favorable a la regulación de la teleconsulta en el país.