Eighteen years of TelessaúdeRS in Brazilian Primary Health Care: main actions and achieved resultsAbstract
TelessaúdeRS was created 18 years ago to improve people’s health. This article presents its main results. This study aims to summarize and present the main outcomes of TelessaúdeRS. Program actions, publications, and databases from the past 18 years were reviewed to numerically express the program’s production and impact. Linked to UFRGS and HCPA, the project started with asynchronous text-based teleconsultations and evolved to synchronous and phone consultations, increasing access and efficiency. Additionally, it supported the regulation of referrals to specialized care in Rio Grande do Sul, with more than 500,000 discussions. The project also developed remote diagnostic services in spirometry, ophthalmology, dermatology, and stomatology, performing 700,000 telediagnostics and improving healthcare access. Furthermore, it supports the judiciary by applying evidence-based medicine to legal claims. Over 18 years, TelessaúdeRS has achieved its initial goals, expanded its scope, filled care gaps, supported primary care, and improved the healthcare system’s efficiency.
Key words:
Telehealth; Telemedicine; Primary care; Telediagnostics; Teleconsultations
Resumo
O TelessaúdeRS foi criado há 18 anos para melhorar a saúde das pessoas. Este artigo apresenta seus principais resultados. O objetivo deste estudo é resumir e apresentar os resultados do TelessaúdeRS. Estudo descritivo. Foram revisadas as ações, publicações e compilados os dados do programa ao longo dos últimos 18 anos para expressar numericamente sua produção e impacto. Vinculado à UFRGS e ao HCPA, o projeto começou com teleconsultorias assíncronas e evoluiu para consultorias síncronas e telefônicas, ampliando o acesso e a agilidade. Associadamente, iniciou-se o suporte à regulação de encaminhamentos para atenção especializada no RS. Essas iniciativas somaram mais de meio milhão de discussões de caso clínico. O projeto também criou serviços de diagnóstico remoto em espirometria, oftalmologia, dermatologia e estomatologia, realizando 700 mil telediagnósticos, ampliando o acesso à saúde. Além disso, oferece apoio ao poder judiciário, aplicando medicina baseada em evidências nos pleitos judiciais relacionados à saúde. Em 18 anos, o TelessaúdeRS alcançou seus objetivos iniciais, ampliando sua atuação para preencher lacunas assistenciais, apoiar a atenção primária e melhorar a eficiência do sistema de saúde.
Palavras-chave:
Telessaúde; Telemedicina; Atenção primária; Telediagnóstico; Teleconsultoria
Resumen
TelessaúdeRS fue creado hace 18 años con el objetivo de mejorar la salud de las personas. Este artículo presenta sus principales resultados. El objetivo es resumir y presentar los principales resultados de TelessaúdeRS. Se revisaron las acciones, publicaciones y bases de datos del programa de los últimos 18 años para expresar numéricamente su producción e impacto. Vinculado a la UFRGS y al HCPA, el proyecto comenzó con teleconsultas asincrónicas y evolucionó hacia teleconsultas sincrónicas y telefónicas, aumentando el acceso y la agilidad. Además, apoyó la regulación de derivaciones a atención especializada en Rio Grande do Sul, con más de 500,000 discusiones. También desarrolló servicios de diagnóstico remoto en espirometría, oftalmología, dermatología y estomatología, realizando 700,000 telediagnósticos que mejoraron el acceso a la salud. Asimismo, brinda apoyo al poder judicial aplicando medicina basada en evidencia en casos legales. En 18 años, TelessaúdeRS logró sus objetivos iniciales, amplió su alcance, llenó vacíos asistenciales, apoyó la atención primaria y mejoró la eficiencia del sistema de salud.
Palabras clave:
Telesalud; Telemedicina; Atención primaria; Telediagnóstico; Consultas
Introduction
TelessaúdeRS is a health service and meta-service1 that leverages information and communication technologies to address health issues affecting people’s lives and strengthen the Unified Health System (SUS). It provides direct care to individuals (telediagnosis) and a meta-service that supports clinical decision-making for doctors and health professionals in PHC. TelessaúdeRS overarching goal is to improve people’s lives by developing direct care strategies and supporting healthcare services, ensuring quality: the right patient, in the right place, with the right professional, at the right time.
Institutionally, TelessaúdeRS is a consortium of projects funded by entities connected to the Federal University of Rio Grande do Sul (UFRGS), particularly its Department of Social Medicine, Postgraduate Program in Epidemiology, Faculty of Medicine, Faculty of Dentistry, and Hospital de Clínicas de Porto Alegre (HCPA).
To achieve its objectives, TelessaúdeRS receives institutional support from the UFRGS Support Foundation, the Medical Foundation of Rio Grande do Sul, and HCPA. Continuous services are ensured through organizational cross-functionality, with support activities and collaborator dedication distributed among projects, using compensatory measures for effective public fund use and greater service delivery efficiency.
In November 2024, TelessaúdeRS employed 221 staff, including 114 health professionals. It has a strong academic focus, with 66 undergraduates, 12 master’s students, 23 doctoral students, and 12 UFRGS professors. The project occupies over 1,200 m² in two locations outside the University. It is connected to the National Education and Research Network (RNP) and features robust computing, server, and furnishing infrastructure, as well as its own physical and digital library. Its Telehealth Platform contains six modules, receiving an average of 3,000 to 4,000 monthly visits.
TelessaúdeRS participates in a national network of telehealth centers. Similar to TelessaúdeRS, other states operate robust Telehealth Centers within SUS, advancing population health. For instance, the Telehealth Center at Hospital das Clínicas of the Federal University of Minas Gerais delivers comprehensive remote diagnostic services in cardiology, consultations, education, and support. Similarly, the Santa Catarina center, affiliated with the federal university, excels in telediagnosis (notably dermatology), distance education, and content development. The Amazonas center focuses on providing consultations, a demanding task due to the state’s vast territory and its many remote areas. The Goiás center specializes in a range of diagnostic services, with particular strength in ophthalmology.
This descriptive article presents a historical review of TelessaúdeRS. It details the project’s evolution from its initial concept and context to its organization, funding, and implementation. The article also highlights the main results and related publications.
The TelessaúdeRS development and expansion background
TelessaúdeRS began its activities in March 2007, with funding from the Pan American Health Organization (PAHO), in partnership with the Secretariat for Education and Labor Management (SGTES) of the Ministry of Health (MS), within the pilot project of Telehealth Centers in Support of PHC. Telessaúde RS first actions provided text and video teleconsultations in support of health professionals in the Family Health Strategy (ESF), as well as delivered educational activities. Initially, TelessaúdeRS offered its services to 100 telehealth points, that is, 100 PHC Units (UBS). In 2012, TelessaúdeRS offered teleconsultations to all ESF teams in the state of Rio Grande do Sul. At the national level, in 2011, the Ministry of Health contracted TelessaúdeRS for two nationwide initiatives: creating the National Telehealth Platform, an electronic platform that managed requests and responses to teleconsultations, as well as supporting the emergence of new Telehealth Centers in the country.
In 2013, TelessaúdeRS launched a toll-free telephone teleconsultation channel (Channel 0800), funded by the Ministry of Health; that is, a direct contact telephone line with teleconsultants who provided synchronous and immediate responses to resolve clinical questions from PHC professionals. In parallel, and with the support of Channel 0800, also in 2013, and with funding from the Rio Grande do Sul State Health Secretariat (SES-RS), the TelessaúdeRS team began managing some waiting lists for specialized consultations for patients from the rural region of Rio Grande do Sul to Porto Alegre. This was the embryo of the RegulaSUS project, delivering teleconsultations to support primary care doctors for all cases that did not meet the criteria for referral to in-person consultations with specialists. In the same year, it began offering telediagnosis through asynchronous diagnosis in spirometry (RespiraNet).
Subsequently, in 2017, the asynchronous diagnosis of oral cavity lesions, EstomatoNet, was launched, as well as telediagnosis in dermatology (DermatoNet). Also, TelessaúdeRS launched its synchronous diagnostic methodology in ophthalmology, Teleoftalmo.
In 2019, expanding its capacity to intervene in multiple problems within the healthcare system, TelessaúdeRS, based on many years of accumulated experience in selecting, evaluating, and disseminating the best available scientific evidence adapted for PHC, began supporting the Judiciary by issuing technical opinions in the judicialization process for access to medications not included in the official SUS list. Figure 1 shows a timeline summarizing these main actions.
During this long process, methodologies for selecting, evaluating, and adapting evidence for the context of PHC within the SUS were developed, as well as several electronic tools, such as the Telehealth Platform and applications to support clinical decision-making. Together, the development of these technologies led to the creation of 22 original patents.
Main actions and their results
In this session, we will present the principal services and actions of TelessaúdeRS and their main results. An overview is shown in Chart 1. The main actions and services developed by TelessaúdeRS in the last 18 years are summarized in the paragraphs below. We chose to detail those with the highest volume and, consequently, those that generate an impact on a greater number of people. Despite this, initiatives in dentistry2,3, nursing4,5, nutrition6, education7,8, and care transition9,10 are also significant within the project.
Consulting services for primary healthcare professionals
TelessaúdeRS began its activities offering asynchronous teleconsultations via text and video to Family Health teams. As an opportunity to expand the service nationally and support the Mais Médicos Program, in 2013, a simplified, faster, and more widespread alternative way of offering consultations was developed. Thus, the 0800 consultation hotline for all ESFs in the country was created, and has become TelessaúdeRS best-known initiative over the years.
This initiative aimed to provide direct answers to clinical questions based on the best available scientific knowledge, which arise on average 5 times per shift11. Moving from asynchronous consultations to synchronous telephone discussions facilitated a faster exchange of information, which offered an understanding of the context in more detail and provided an answer that applied the best scientific knowledge to the required context. To achieve this goal, it was essential to have proficient family and community doctors as principal consultants and responsible for most of the responses, and a team of medical specialists in other fields, such as cardiologists, dermatologists, endocrinologists, pulmonologists, and psychiatrists.
This service was active between 2013 and 2024. The TelessaúdeRS 0800 hotline answered 458,616 inquiries from all Brazilian states over more than 10 years of existence. In total, 26,466 different professionals called the service, discussing cases of a multitude of different diseases and clinical situations. As a group, dermatological, endocrinological, and genitourinary diseases were the most frequently asked about; individually, type 2 diabetes mellitus, COVID-1912, and chronic kidney disease were the most common topics. As a result of these discussions, 72% of the cases discussed could be managed within PHC, without waiting for timely specialized care and without the need for referral to secondary and tertiary care centers, thus avoiding travel to other points in the network and increasing the system’s efficiency.
Furthermore, as a result of the ongoing process of reviewing medical literature and providing the best scientific answers to recurring questions, the Questions of the Week have emerged. These are educational resources, direct answers to frequently asked questions received through the 0800 hotline, focused on specific, common PHC clinical situations, based on a review of the main references on the subject, published on the TelessaúdeRS website, and sources of immediate consultation for healthcare professionals. Over the past 3 years, more than 9 million visits have been made to the website to consult the 359 Questions of the Week already published. Almost two million of these were from outside Brazil, from all continents and 205 different countries. Access from Portuguese-speaking countries (except Brazil) stands out with 318,015 visits.
Support for outpatient regulation
Right from the first asynchronous text-based consultations (and later, in discussions via the 0800 hotline), the fraction of cases requiring referral to specialist care after contact with TelessaúdeRS stood at approximately 30%. Furthermore, when PHC doctors intended to refer patients before case discussions, this intention often did not clearly represent a need for consultation with a specialist doctor13; that is, these were clinical situations that could be managed within the PHC context. In other words, it was highly likely that by offering information and support to PHC doctors, most cases generating doubts would not require specialist care. With this in mind, TelessaúdeRS and SES-RS began exploring the effects of telehealth interventions on the long waiting lists for outpatient consultations and procedures.
The RegulaSUS service was established through a methodology similar to that used to respond to consultations (using the best available evidence applied to the patient’s context). With a seven-step structured method, each waiting list could be studied, and referral protocols could be created14. The steps involve selecting the waiting list with critical access, evaluating a sample of referrals to understand the most common diseases or clinical situations, and performing a demand diagnosis. Protocols were devised starting with the diseases that made up 70-90% of the waiting list, based on existing literature and the SUS characteristics that define which patients can be managed in PHC, which clinical situations should go to specialized care, and which ones are prioritized for scheduling. Currently, they are reviewed and updated periodically. The protocols also define the minimum information that the referral must contain for adequate clinical judgment by the outpatient regulation team.
Defined criteria allow addressing the waiting lists for specialist consultations in Rio Grande do Sul. A TelessaúdeRS regulating doctor manages all cases on a specific waiting list (for example, adult neurology) jointly with the SES-RS State Consultation Regulation Center, moving away from a reactive approach and pivoting the regulation of the entire list, organizing legitimate demand, and prioritizing patients with the highest risk of health problems. Just as important as having a clear understanding of the demand is being able to offer consultations via the 0800 hotline to PHC doctors for referrals that are not eligible for in-person specialist consultation. Thus, TelessaúdeRS manages all cases on a waiting list, establishes the clinical priority level of each case, schedules priority cases, and refers all cases that do not meet the referral criteria defined in the Regulation Protocols to teleconsultation via the 0800 hotline. In short, the strategy as a whole enhances the efficient use of resources. It also provides the manager with the possibility of reducing or expanding services according to the identified demand.
From 2013 to 2024, 161,779 referral cases were discussed, and nearly one million referrals were managed by TelessaúdeRS. This strategy curbed the waiting time for specialist consultations by 23 days overall, lowering it from approximately 600 days to less than 250 days in priority cases15. In addition, a total of 347 referral protocols in 45 different specialties were produced and used in Rio Grande do Sul and many other places in Brazil. One hundred nineteen of these were endorsed by the Ministry of Health with national validity.
Telediagnosis: spirometry
Even in the early years of the project, respiratory diseases were identified as the third leading cause of death in Rio Grande do Sul, which differed from the rest of the country and even from other states in the Southern region. This fact provided an opportunity to analyze referrals to pulmonology in a medium-sized municipality known for coal mining, revealing that spirometry was unavailable to PHC patients in Rio Grande do Sul. As care for people with chronic lung diseases was established, they needed to be referred to a pulmonologist who would then request a pulmonary function test, essential for the diagnosis and management of asthma and COPD16,17. To solve this problem, the idea for RespiraNet emerged, and, since 2013, this program has offered spirometry to the entire population of Rio Grande do Sul.
Targeting better integration with the care routine, any doctor registered in PHC in Rio Grande do Sul can access the TelessaúdeRS platform and provide basic patient data and clinical information. Then, the patient is directed to one of the RespiraNet centers to undergo remote spirometry. At these locations, a trained technician performs the examination. From this data collection, the patient’s respiratory curves are uploaded to the platform, and a pulmonologist from TelessaúdeRS evaluates them and provides an online report, following the recommendations of the most current guidelines.
To date, 42,418 spirometry tests have been performed, requested by approximately 3,000 different professionals in six telediagnosis centers distributed throughout the state. For comparison, between 30,000 and 40,000 referrals to pulmonology in Rio Grande do Sul are estimated in the same period. With spirometry tests, countless referrals to specialized care aimed solely at performing this examination have been avoided. The average time between requesting the exam and receiving the report is 60 days, and doctors receive the results via an app on their cell phones. Although there is no direct data for comparison, it can be inferred that this time is significantly shorter than the previous one, since it eliminates the need for referral to a pulmonologist and the internal (and heterogeneous) waiting time of each specialized service.
Telediagnosis: ophthalmology
With the success of the RespiraNet strategy, other bottlenecks in access to the healthcare system for the population of Rio Grande do Sul were analyzed in order to identify which of them a telediagnosis service could bring benefits to. Long waiting lists for ophthalmology, with waiting times of more than a year, were one of the problems selected. Thus, in 2015, a call for proposals from the Ministry of Health’s Secretariat of Science, Technology, and Strategic Inputs provided an incentive to create a large task force involving several areas of UFRGS (TelessaúdeRS, Institute for Health Technology Assessment, Institute of Informatics, Data Processing Center) together with SES-RS to compete with an innovative project in eye health. The Teleoftalmo project was selected to receive funding through a grant program. However, due to the economic crisis that hit the country, the grant was cancelled, and other ways of financing this disruptive strategy for accessing ophthalmology were sought. In this search for partners, Hospital Moinhos de Vento, through the PROADI-SUS project, was chosen as the partner that could finance the acquisition of ophthalmological equipment and provide logistical support for the creation of Teleophthalmology, with seven fully equipped ophthalmology clinics strategically distributed throughout Rio Grande do Sul.
This service is fully integrated into the healthcare services offered by the state of Rio Grande do Sul. The PHC doctor submits a teleconsultation request through the state’s referral system, in the same way they refer a patient to any specialty. Based on this request, the TelessaúdeRS team locates the remote clinic closest to the patient’s home and schedules an appointment. On the day of the evaluation, the patient is greeted by a team of technicians and nurses who collect samples for tests such as retinography and intraocular pressure18. Throughout the evaluation, an ophthalmologist from TelessaúdeRS participates synchronously in part of the assessment, using telepresence tools, to complement the evaluation, mainly the analysis of ocular acuity, and to define management recommendations for the referring doctor.
To date, approximately 60,000 people have been evaluated in the Teleoftalmo remote clinics and received a diagnosis remotely, with less need for travel. The accuracy of the initiative has proven to be similar to in-person care19. In addition, the service has the same quality as in-person care, with economic benefits for the health system20. The patient’s needs were resolved without requiring a follow-up in-person consultation21 in 70% of cases, and prescriptions for lenses were issued when necessary. When an additional in-person consultation was imperative, it was usually for surgical procedures. Currently, there are six remote clinics spread across Rio Grande do Sul conducting the collections.
Telediagnosis: dermatology and stomatology
With the growing demand for consultations through the 0800 hotline and coupled with the popularization of smartphones with progressively better cameras, TelessaúdeRS began receiving a large number of clinical images to complement telephone consultations. This created the opportunity and need for specific diagnostic services in dermatology and stomatology: DermatoNet and EstomatoNet. Their creation was also based on the perception that asynchronous data collection did not compromise the quality of the response provided for some consultation types.
The operating procedure is similar to that of spirometry: the primary healthcare professional (doctor or dentist) enters the TelessaúdeRS platform and generates a telediagnosis request, answering questions about the case and attaching clinical images, with guidance on the website and platform on how to acquire better images. Based on this information and images, the dermatologist and dentist consultants of TelessaúdeRS evaluate the case and provide diagnostic hypotheses and treatment suggestions to the PHC professional, who then applies them in the application or on the platform.
Regarding DermatoNet, 28,517 assessments were performed for remote diagnosis, meaning 250 to 300 monthly consultations since the service began. With these responses, 72% of patients did not require referral to a specialist. Similarly, in EstomatoNet, almost 5,000 reports were produced by 778 different professionals, with a PHC resolution rate of 62%. In both initiatives, the waiting time for the report was less than 7 days (while the waiting time for dermatology was 111 days, and 147 days for stomatology).
The contribution of TelessaúdeRS to the development of NAT-Jus and its impacts on the judicialization of healthcare
In 2016, TelessaúdeRS was invited to participate in the meetings of the Rio Grande do Sul State Health Committee of the National Council of Justice to discuss the creation of a Judicial Technical Support Center (NAT-Jus) in the State, in accordance with the CNJ. These meetings culminated in workshops and discussions with other NAT-Jus in Brazil, the CNJ, and the Ministry of Health, through its Department for the Management of Health Litigation Demands. From 2016 to 2019, the NAT-Jus project underwent several piloting and development stages, allowing the construction of a technical note model that met the following objectives: (i) to provide magistrates with relevant information for decision-making; (ii) to align with the structure of the national system of technical notes in health (e-NAT-Jus); and (iii) to use evidence-based medicine (EBM) to support the analyses.
Currently, TelessaúdeRS acts as a NAT-Jus for the Federal Court of Rio Grande do Sul and the Court of Justice of the state of Rondônia. Technical assessments are performed through judicial summons, which provide access to relevant medical documentation, specifying the health technology in question and the applicant’s clinical context, with confidentiality and secrecy. Based on this data, a multidisciplinary team trained in Evidence-Based Medicine (EBM) conducts a review of the scientific literature to produce individualized technical reports, addressing the efficacy, accuracy, effectiveness, safety, and cost-effectiveness of the requested health technologies.
Using data from 2024, NAT-Jus’ technical reports were identified in 28% of health-related cases in the Federal Court of Rio Grande do Sul (1,339 reports in 4,649 cases). In the Rondônia court, during the same period, we were involved in almost two-thirds of health-related cases (907 technical reports in 1,541 health-related cases). During this period (from 2019 to November 2024), TelessaúdeRS produced 7,422 technical assessments with an average preparation time of 24 days, of which 83% resulted in recommendations unfavorable to the judicial decision. These recommendations are based on factors such as imprecise clinical indications, patient safety-related concerns, better therapeutic alternatives, the limited available evidence, and cost-effectiveness limitations. We should underscore that the NAT-Jus of TelessaúdeRS is the only one in Brazil, to date, to include cost-effectiveness analyses in its evaluations.
Furthermore, historical analysis shows that in 87% of technical evaluations, the first body’s decision was in agreement with the opinion issued by TelessaúdeRS, reflecting the relevance of the technical information provided. Analysis of a sample of 963 cases against the Federal Government and with technical evaluation by TelessaúdeRS showed a 50% reduction in first body rulings compared to data collected by the CNJ22. In this analysis, the estimated potential savings for the set of cases (963) were BRL 142 million. The return on investment was calculated at BRL 106.79 for each BRL invested in the NAT-Jus project of TelessaúdeRS.
These results show that the implementation of evidence-based practices significantly contributes to the rational use of medicines, materials, and procedures in questionable clinical contexts, reducing the financial impact of healthcare litigation on public resources.
In addition to the actions mentioned above, we should highlight that TelessaúdeRS always seeks to innovate and explore new frontiers in the use of information and communication technology to improve the SUS, and experimental actions are being tested each year. Remote care for obesity, patients living with ostomies, wound care consultations, and the use of artificial intelligence23 are some examples of services currently being tested by TelessaúdeRS.
Discussion
This article presents a historical and metrics review of TelessaúdeRS. We should underscore that our center is just one among several available in Brazil. Some comparisons are useful for understanding the overall backdrop. The Minas Gerais and Santa Catarina centers have a very similar range of services as they cover consulting, diagnosis, education, and the production of materials. Minas Gerais has a wide range of options for remote diagnosis in cardiology, offering ECG, Holter monitoring, and ambulatory blood pressure monitoring. It has reached the remarkable milestone of more than 10 million reports in several Brazilian states. This center also has a solid scientific output24,25.
Similarly, the center linked to the Federal University of Santa Catarina offers telediagnosis in dermatology, stomatology, spirometry, and polysomnography, among others. Its courses and lectures cover diverse topics and are offered frequently, which is a challenge to maintain. They also produce telehealth knowledge, contributing to Brazilian scientific development in the field26,27. A notable common point is the marked reduction in the number of unnecessary referrals to specialized care through the use of telehealth and consultation tools homogeneously across Rio Grande do Sul, Santa Catarina, and Minas Gerais.
We need to highlight some limitations of this TelessaúdeRS description. It is a historical, descriptive, and reflective perspective of the center, written by its members - and, therefore, from an internal viewpoint. In other words, it is an introductory article and a snapshot of the current situation. Based on the information presented here, we cannot make firm inferences about the project’s effectiveness or control for the several confounding factors inherent in the fact that TelessaúdeRS focuses on specific needs and uses experimental (controlled), targeted approaches. Other studies and publications from the group may be useful to complement this view and are cited throughout the text.
Furthermore, we still have several unanswered questions to explore through research or service offerings. There is clearly room for wider integration between the country’s telehealth centers and electronic health record systems; the flow of clinical information in the country is still not very linear or integrated, highly prone to disruptions, and exposing patients to risks. Telehealth tools can play a central role in improving this situation.
Specifically, TelessaúdeRS still has a long way to go to reduce the time between the conception of a solution, its testing, and its availability to the general population. As just one example, our counseling service for people with obesity was piloted in 2019. The controlled clinical trial is being finalized in 2025, with uncertain prospects for its adoption for routine use. Finally, many of our actions need to have their effectiveness and cost-effectiveness proven. This has already been explored for ophthalmological diagnosis and regulatory support, but there is still much room for study.
Conclusion: TelessaúdeRS today and the future
After 18 years of existence, we can say that TelessaúdeRS has reached its maturity. It is today a consolidated health service and meta-service, a very mature example of how the university can support the strengthening of Primary Health Care and, consequently, of the entire SUS. The results presented so far reveal the power of combining organizational principles, the use of the best available scientific evidence, hard work, and the courage to undertake projects within the sometimes bureaucratic context of the SUS and public universities. In short, paraphrasing Barbara Starfield, TelessaúdeRS shows the impact of the balance between “health needs, technology, and services” on people’s health.
In the coming years, with the inexorable advancement of information and communication technology and artificial intelligence, TelessaúdeRS aims to scale its services through the greatest possible automation in order to cross new frontiers, with new services and actions, thus benefiting an even greater number of people. The goal is always to put health services at the service of improving people’s health and quality of life.
References
- 1 Harzheim E, Chueiri OS, Umpierre RN, Gonçalves MR, Siqueira ACS, D'Avila OP, Bastos CGM, Katz N, Dal Moro RG, Telles LF, Schmitz CAA. Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI. Rev Bras Med Fam Comunidade 2019; 14:1881-1881.
- 2 Roxo-Gonçalves M, Strey JR, Bavaresco CS, Martins MAT, Romanini J, Pilz C, Harzheim E, Umpierre R, Martins MD, Carrard VC. Teledentistry: A Tool to Promote Continuing Education Actions on Oral Medicine for Primary Healthcare Professionals. Telemed J E Health 2017; 23(4):327-333.
- 3 Carrard VC, Roxo Gonçalves M, Rodriguez Strey J, Pilz C, Martins M, Martins MD, Schmitz CA, Dal Moro RG, D'Ávila OP, Rados D, Harzheim E, Gonçalves MR. Telediagnosis of oral lesions in primary care: The EstomatoNet Program. Oral Dis 2018; 24(6):1012-1019.
- 4 Dias VP, Witt RR, Silveira DT, Kolling JH, Fontanive P, Castro Filho ED, Harzheim E. Telenursing in primary health care: report of experience in southern Brazil. Stud Health Technol Inform 2009; 146:202-206.
- 5 Santos LF, Carvalho F, Rados DV, de Oliveira EB, Gonçalves MR, Katz N, Umpierre RN, Mendonça CS. Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service. Telemed J E Health 2024; 30(1):77-84.
- 6 Gadenz SD, Harzheim E, Rados DRV, Castro SMJ, Drehmer M. Mobile Application Increased Nutrition Knowledge Among Brazilian Physicians. J Nutr Educ Behav 2024; 56(2):92-99.
- 7 Bavaresco CS, Bragança S, Vencato V, Feltes B, Sória GS, Brew MC, de Moura FR, D'Ávila OP, Umpierre RN, Harzheim E, Rodrigues JA. Performance of primary healthcare dentists in a distance learning course in pediatric dentistry. Int J Med Inform 2019; 129:296-302.
- 8 Bavaresco CS, Bragança S, Fries FP, Sória GS, DE Moura FRR, Rivaldo EG, D'Avila OP, Umpierre RN, Harzheim E, Rodrigues JA. Satisfaction of Primary Healthcare Dentists after the Completion of a Distance Learning Course in Pediatric Dentistry. Iran J Public Health 2019; 48(8):1439-1444.
- 9 Ruschel KB, Rados DR, Furtado MV, Batista JDL, Katz N, Harzheim E, Polanczyk CA. Transition of care of stable ischaemic heart disease patients from tertiary to primary care with telemedicine support: Randomized noninferiority clinical trial. J Telemed Telecare 2022; 28(1):52-57.
- 10 Moreira AM, Rados DV, de Farias CB, Coelli S, de Almeida Faller L, Dos Santos LF, Matzenbacher AM, Katz N, Harzeim E, Silveiro SP. Effects of nurse tele support via telephone calls on transition between specialized and primary care in type 2 diabetes mellitus patients: a CONSORT-compliant randomized clinical trial. Endocrine 2025; 87(3):978-986.
- 11 Ebell MH. How to Find Answers to Clinical Questions. afp 2009; 79:293-296.
- 12 Montelongo A, Becker JL, Roman R, de Oliveira EB, Umpierre RN, Gonçalves MR, Silva R, Doniec K, Yetisen AK. The management of COVID-19 cases through telemedicine in Brazil. PLoS One 2021; 16(7):e0254339.
- 13 Grendene GM, Rodrigues ÁS, Katz N, Harzheim E. Referring Quality Assessment of Primary Health Care for Endocrinology in Rio Grande do Sul, Brazil. Stud Health Technol Inform 2015; 216:990.
- 14 Katz N, Roman R, Rados DV, Oliveira EB, Schmitz CAA, Gonçalves MR, Mengue SS, Umpierre RN. Acesso e regulação ao cuidado especializado no Rio Grande do Sul: a estratégia RegulaSUS do TelessaúdeRS-UFRGS. Cien Saude Colet 2020; 25(4):1389-1400.
- 15 Pfeil JN, Rados DV, Roman R, Katz N, Nunes LN, Vigo Á, Harzheim E. A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study. J Telemed Telecare 2023; 29(1):10-17.
- 16 Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J 2023; 61(4):2300239.
- 17 Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, Cruz AA, Duijts L, Drazen JM, FitzGerald JM, Fleming LJ, Inoue H, Ko FW, Krishnan JA, Levy ML, Lin J, Mortimer K, Pitrez PM, Sheikh A, Yorgancioglu AA, Boulet LP. Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes. Am J Respir Crit Care Med 2022; 205(1):17-35.
- 18 Garcia MPC, Moreira TC, Sganzerla D, Matzenbacher AMF, Faria AG, Matturro L, Cabral FC, Rados DRV, Szortyka AD, Falavigna M, Vinadé Chagas ME, Harzheim E, Gonçalves M, Umpierre R, Araujo AL. Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy. PloS One 2021; 16(11):e0260594.
- 19 Araujo AL, Rados DRV, Szortyka AD, Falavigna M, Moreira TC, Hauser L, Gross PB, Lorentz AL, Maturro L, Cabral F, Costa ALFA, Martins TGDS, Silva RS, Schor P, Harzheim E, Gonçalves MR, Umpierre RN. Ophthalmic image acquired by ophthalmologists and by allied health personnel as part of a telemedicine strategy: a comparative study of image quality. Eye (Lond) 2021; 35(5):1398-1404.
- 20 Etges APBDS, Zanotto BS, Ruschel KB, da Silva RS, Oliveira M, de Campos Moreira T, Cabral FC, de Araujo AL, Umpierre RN, Gonçalves MR, Harzheim E, Polanczyk CA. Telemedicine Versus Face-to-Face Care in Ophthalmology: Costs and Utility Measures in a Real-World Setting. Value Health Reg Issues 2022; 28:46-53.
- 21 Araujo AL, Moreira TC, Rados DRV, Gross PB, Molina-Bastos CG, Katz N, Hauser L, Silva RS, Gadenz SD, Dal Moro RG, Cabral FC, Matturro L, Pagano CGM, Faria AG, Falavigna M, Siqueira ACS, Schor P, Gonçalves MR, Umpierre RN, Harzheim E. The use of telemedicine to support Brazilian primary care physicians in managing eye conditions: The TeleOftalmo Project. PloS One 2020; 15(4):e0231034.
- 22 Conselho Nacional de Justiça (CNJ). Judicialização e saúde: ações para acesso à saúde pública de qualidade. Brasília: CNJ; 2021.
- 23 Reis MA, Künas CA, Araújo TS, Schneiders J, Azevedo PB, Nakayama LF, Rados DRV, Umpierre RN, Berwanger O, Lavinsky D, Malerbi FK, Navaux POA, Schaan BD. Advancing healthcare with artificial intelligence: diagnostic accuracy of machine learning algorithm in diagnosis of diabetic retinopathy in the Brazilian population. Diabetol Metab Syndr 2024; 16(1):209.
- 24 Marcolino MS, Palhares DM, Benjamin EJ, Ribeiro AL. Atrial fibrillation: prevalence in a large database of primary care patients in Brazil. Europace 2015; 17(12):1787-1790.
- 25 Maia JX, Sousa LA, Marcolino MS, Cardoso CS, Silva JL, Alkmim MB, Ribeiro AL. The Impact of a Clinical Decision Support System in Diabetes Primary Care Patients in a Developing Country. Diabetes Technol Ther 2016; 18(4):258-263.
- 26 Catapan SC, Melo EA, Silva AB, Albuquerque MV, Calvo MCM. Teleassistência no Sistema Único de Saúde brasileiro: onde estamos e para onde vamos? Cien Saude Colet 2024; 29(7):e03302024.
- 27 Catapan SC, Bruckmann G, Nilson LG, Caffery LJ, Kelly JT, Calvo MCM, Boing AF. Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil. J Telemed Telecare 2024; 31(7):1014-1023.
The data sources adopted in the research are indicated in the article’s body.
*In 2024, the 0800 Channel remained active for Rio Grande do Sul, with funding from the SES-RS (State Health Secretariat of Rio Grande do Sul) to support regulation, but was discontinued nationally by decision of the Secretariat of Information and Digital Health and the Secretariat of Primary Health Care of the Ministry of Health, which did not renew the agreement between the Ministry of Health and UFRGS (TelessaúdeRS). Source: TelessaúdeRS, November 2024.