Untitled - Departamento de Informática em Saúde
Transcrição
Untitled - Departamento de Informática em Saúde
Dear Colleague, th The abstracts received by the 10 Congress Of the International Society of Telemedicine and e-Health, the 2nd Congress of the Brazilian Council of Telemedicine and e-Health and the 2nd Meeting of the Latin-American and Caribbean Chapter of the American Telemedicine Association are edited in this CD-ROM. They are published as they were sent; only a uniform layout was given. An alphabetic sequence using the surname of the first author was followed. Abstracts written in Portuguese and English were not separated; whenever a choice was given the English version was used, as it is the international language of Science. Whether it was a poster or oral presentation is not indicated. An index was elaborated with all authors linked to their contributions which we sincerely appreciated. São Paulo, October 23, 2005 The Organizing Committee Prezado Colega, Os resumos dos trabalhos enviados para o 10º Congresso da Sociedade Internacional de Telemedicina e Telessaúde, o 2º Congresso Brasileiro de Telemedicina e Telessaúde e o 2º Encontro do Capítulo Latino Americano e Caribenho da Associação Americana de Telemedicina estão reunidos neste CD-ROM. Estamos publicando tal como foram recebidos, apenas uniformizando o formato geral. A seqüência é alfabética sempre considerando o sobrenome do primeiro autor. Não houve separação dos resumos encaminhados em português e inglês; sempre que tivemos opção usamos a versão inglesa por ser a língua internacional da ciência. O tipo de apresentação, se pôster ou oral, não é indicado. Procuramos elaborar um índice com todos os autores vinculados às suas contribuições que, sinceramente, agradecemos. São Paulo, 23 de outubro de 2005 A Comissão Organizadora Abreu, I.M. Batiz, M.G. Carniglia, L. Artigo 1 Artigo 1 Artigo 2 Artigo 1 Carvalho, I.M.M. Ajzen, S. Artigo 1 Bedi, B.S. Artigo 1 Artigo 1 Artigo 2 Bekteshi, F. Carvalho, M.L.M. Artigo 1 Artigo 1 Bento, R.F. Carvalho, R.S. Artigo Artigo Artigo Artigo Artigo 1 Alencar, A. Artigo 1 Alkmim, M.B. Artigo 1 Artigo 2 Artigo 3 Almeida, A.L. 1 2 3 4 Cassetti, I. Artigo 1 Artigo 1 Almeida, M.E.B.T.M.P. Bhaskaranarayana, A. Castilio, D. Artigo 1 Artigo 1 Böhm, G.M. Cavalcanti, S. Artigo 1 Artigo 1 Borges, C.L. Chao, LW Artigo 1 Artigo 2 Artigo 3 Artigo 1 Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Artigo Brady, P. Chiari, J.P. Artigo 1 Artigo 1 Campelo, V.E.S. Cogo, A.L.P. Artigo Artigo Artigo Artigo Artigo 1 Artigo 1 Alves, L.C. Artigo 1 Alves, R.H.K. Artigo 1 Alvin, F.B. Artigo 1 Borghi, G. Artigo 1 Andrade, V.G. Artigo 1 Artigo 2 Bossi, G.A. Artigo 1 Artigo 2 Andreazzi, D.B. Artigo 1 Bossi, G.A.M. Artigo 1 Atta, M.T. Artigo 1 Brady, F. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Azevedo, D.F.G. Artigo 1 Azevedo, R. Artigo 1 Barsottini, C.G.N. Artigo Artigo Artigo Artigo 1 2 3 4 1 2 3 4 Conrado, M.A. Filgueiras, T. Guzovsky, P.A. Artigo 1 Artigo 1 Artigo 1 Corrêa, F.G.C. Fonseca, L.M. Hammes, E. Artigo 1 Artigo 1 Artigo 1 Dalpino, N. R. S. Fortuin, J.B. Holcomb, M. Artigo 1 Daré Junior, S. Artigo 1 Fregonara, M. Artigo 1 Hovenga, J.S. Artigo 1 Artigo 1 Artigo 2 Debbag, R. Freitas, M.A.V. Johnson, P. Artigo 1 Artigo 1 Artigo 1 Artigo 1 De-Lorme, P. García, F. Artigo 1 Artigo 1 Diniz, C.G.P. Garcia, G.B. Artigo 1 Domingues, L.A. Artigo 1 Artigo 1 Gimenez, R.S.S. Artigo 1 Artigo 1 Jakobi, H.R. Artigo 1 Jordanova, M. Artigo 1 Judkins, D. Gismondi, R.C. Artigo 1 Artigo 1 Artigo 1 Artigo 2 Juliani, M.C.M Enrique S. Godoy, I. Artigo 1 Artigo 2 Artigo 1 Artigo 1 Fernandes G.C.V.R. Godoy, S. Eisenstein, E. Artigo 1 Ferreira E.G.P. Artigo 1 Ferreira S.R.G. Artigo 1 Godoy, S.C.B. Junior, M.J. Artigo 1 Kachienga, M.A. Artigo 1 Artigo 1 Grottone, G. Kashiabara, J.A. Artigo 1 Artigo 1 Guerra, I. M. Kelmer, S. Artigo 1 Artigo 1 Guimarães, E.M.P. Kiefer, S. Artigo 1 Ferreira, W.S. Artigo 1 Festa C.N. Artigo 1 Artigo 1 Artigo 2 Gundim, R.S. Figueiredo, L Artigo 1 Artigo 2 Artigo 1 Artigo 2 Artigo 1 Kurcgant, P. Artigo 1 Gutierrez, M.A. Latifi, R. Artigo 1 Artigo 1 Artigo 2 Artigo 3 Legramandi, D.B. Merrell, R.C. Neto, J.R.N Artigo 1 Artigo 1 Artigo 1 Leite, M.M.J. Messina, L.A. Nobre, L.F. Artigo 1 Artigo 1 Lievens, F. Miot, H.A. Artigo 1 Artigo 2 Artigo 3 Artigo 1 Artigo 1 Nogueira, M.S. Lombroso, F. Molefi, M. Artigo 1 Artigo 1 Artigo 1 Nunes, A.A. Lopes, P.R.L. Molefi, M.L. Artigo Artigo Artigo Artigo Artigo Artigo 1 1 2 3 4 5 Machado, H.R. Artigo 1 Ohl, R. Monteiro, A. Olurunju, S. Monteiro, A.M.V. Artigo 1 Artigo 1 Artigo 2 Artigo 3 Paixão, M.P. Mortara, A.M. Pegoraro, C.N. Artigo 1 Artigo 1 Moshela, M. Peixoto, F.C. Artigo 1 Artigo 1 Artigo 2 Malmström, M.F.V. Artigo 1 Mancini, F. Artigo 1 Pereira, A. J. Artigo 1 Mário Jr., M.J. Múnera, L.E.S. Artigo 1 Peres, H.H.C. Artigo 1 Marta, S.N. Artigo 1 Artigo 2 Artigo 1 Muja, S.H. Artigo 1 Artigo 1 Artigo 1 Artigo 1 Maia, C.C.A. Artigo 1 Artigo 1 Murthy, R.L.N. Artigo 1 Petitet, A. Artigo 1 Medeiros, R. Nason, A.M. Artigo 1 Artigo 2 Artigo 1 Pinheiro Neto, C.D. Navarro Newball, A.A. Artigo 1 Artigo 2 Artigo 3 Melare, D. Artigo 1 Melo, M.C. Artigo 1 Artigo 2 Artigo 3 Pinto, V.C. Artigo 1 Artigo 1 Pires, F.S. Mendes,I.A.C. Artigo 1 Artigo 1 Pisa, I.T. Sachpazidis, I Sequeira, E. Artigo Artigo Artigo Artigo Artigo Artigo 1 Artigo 2 Artigo Artigo Artigo Artigo Artigo Artigo 1 2 3 4 5 Sakas, G. Artigo 1 Ponokowski, P. Salas, L.C. Artigo 1 Artigo 1 Porter, J. Salvatore, P. Artigo 1 Artigo 1 Porter, J.M. Santos, A.A.S Artigo 1 Artigo 1 Artigo 2 Prudent, L. 1 2 3 4 5 6 Sgavioli, C.A.P.P. Artigo Artigo Artigo Artigo 1 2 3 4 Sigulem, D. Artigo 1 Artigo 2 Artigo 3 Artigo 1 Santos, A.F. Reis, M.C.S. Silva, A.P.S.S. Artigo 1 Artigo 1 Artigo 2 Artigo 3 Ribeiro, M.A.C. Santos, D.T. Silva, I.M. Artigo 1 Artigo 1 Richardson, R.J. Santos, S.F. Artigo 1 Artigo 2 Artigo 3 Artigo 1 Artigo Artigo Artigo Artigo Ricur, G. Artigo 1 Artigo 2 1 2 3 4 Sakuno, T. Rocha, G.Z. Artigo 1 Soares, E.R. Artigo 1 Soares, R.C.F.R. Artigo 1 Artigo 1 Artigo 2 Sarkis, C. Soares, S Artigo 1 Artigo 1 Artigo 2 Artigo 1 Roque, A.C. Artigo 1 Satyamurthy, L.S. Rosa, V.T.A. Artigo 1 Artigo 1 Sousa, R.M. Artigo 1 Schaun, T.R. Rossi, F. Artigo 1 Souza, C. Schor, P. Artigo 1 Artigo 2 Artigo 3 Artigo 1 Russomano, T. Artigo 1 Artigo 2 Artigo 3 Artigo 1 Artigo 2 Scott, R.E. Artigo 1 Souza, C.A. Artigo 1 Sparenberg, A.L.F. Vujacich, C. Artigo 1 Artigo 2 Artigo 3 Artigo 1 Young, E. Artigo 1 Spiri, W.C. Artigo 1 Wainer, J. Sproule, K. Artigo 1 Artigo 2 Artigo 1 Wangenheim, A. Stamboulian, D. Artigo 1 Artigo 1 Weinstein, R. Szabo, C.A. Artigo 1 Artigo 1 Whalen, E. Szomorovszky, S.V. Artigo 1 Artigo 1 Williams, M.D. Tachinardi, U.A.S. Artigo 1 Artigo 1 Zaldivar, R. Thornby, D. Artigo 1 Timm, R. Artigo 1 Togashi, G.B. Artigo 1 Trindade, M.A.B. Artigo 1 Artigo 2 Vazquez, L. Artigo 1 Vélez Beltrán, J.A. Artigo 1 Artigo 2 Artigo 3 Veronezi, M.C. Artigo 1 Artigo 2 Artigo 3 Voegels, R.L. Artigo 1 Artigo 1 Artigo 2 A DINÂMICA DE ENFERMAGEM EM SERVIÇO DE URGÊNCIAS COM SISTEMA DE TELE-ECG DIGITAL NO SUL DO BRASIL Soares, E. R.; Schaun, T.R.; Russomano, T.; Sparenberg, A. Laboratório de Microgravidade/IPCT-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil. Associação Médica de São Lourenço do Sul, RS, Brasil INTRODUÇÃO. Pequenas cidades e áreas rurais no Brasil são carentes de cardiologistas, o que prejudica a análise de Eletrocardiogramas (ECGs), especialmente os exames emergenciais. A transmissão em tempo real (on-line) de ECGs permite o rápido estabelecimento de diagnósticos cardiológicos. MATERIAL E MÉTODOS. À partir de janeiro de 2000, a sala de urgências do Hospital Santa Casa de Misericórdia de São Lourenço do Sul (HSCM-SLS), RS, adotou um Sistema de Tele-ECG Digital (SED), o qual permite o registro, a transmissão e análise em tempo real e o armazenamento dos dados eletrocardiográficos. O SED inclui uma aparelho digital de ECG, computadores, software de comunicação (pcANYWHERE, versão 10.5, Symantec), modem ligado à linha fixa de telefonia e telefone celular remoto (9600 bits/s). A equipe de enfermagem, a quem compete orientar e treinar a realização dos exames, é composta por uma coordenação geral, enfermeiras supervisoras de turno e técnicos e auxiliares de enfermagem. RESULTADOS. No período de 17/11/2003 à 16/11/2004 foram analisados 604 exames, com tempo médio de transmissão e análise de 8,05 min (DP 1,6). A média etária foi de 58,7 anos. Na amostra, 321 (53.15%) pacientes foram do sexo feminino e 283 (46.85%) do sexo masculino, incluindo 176 (29.14%) exames normais e 428 (70.86%) com diagnósticos eletrocardiográficos patológicos. CONCLUSÃO. O SED constitui-se em método de baixo custo e que permite o diagnóstico precoce de urgências cardiológicas, trazendo grande benefício para a dinâmica do Serviço de Enfermagem, ao ser empregado em cidade de pequeno porte. [email protected] [email protected] INDICE/INDEX A MODEL OF TELEHEALTH BETWEEN UNIVERSITY HOSPITAL AND PRIMARY CARE SECTOR OF THE MUNICIPAL HEALTH SYSTEM OF BELO HORIZONTE Santos, A.F.; Alkmim, M.B.; Silva, I.M.; Souza, C.; Santos, S.F.; Peixoto, F.C.; Bossi, G.A.; Alves, L.C.. Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil; Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; PRODABEL - Empresa de Informática e Informação do Município de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil. The BH TELEMED project is a Telemedicine and Telehealth project for primary care, made for the family health teams in the city of Belo Horizonte and financed by the @LIS line of the European Union and the Ministry of Health. It interconnects the "Hospital das Clínicas"(HC) of the Federal University of Minas Gerais(UFMG) and the Health Centers of the Municipal Health Department through a long distance consulting system with teleconsultations and specific theme discussions. Its objective is to promote permanent in-service training and to improve the effectiveness of the primary health network. The project is composed of Telemedicine, Telenursing and Teleodontology activities. The body of Teleconsultants is made up of 50 doctors, 10 nurses and 2 dentists of the UFMG. The defined model is to carry out teleconsultations scheduled according to spontaneous demand, discuss themes based on clinical cases and themes programmed according to statistical data of specialised consultations. The technology used is simple and not expensive (computers and webcams) allowing a simultaneous on-line access of all the participating units, with image, voice and/or chat interaction. In the first 15 months of the project there was a gradual implementation of the system in 17 health centers, development of the on-line module of the Teleconsulting Management software, the interconnection of the network and the stabilisation of the system. In the period 103 events were carried out (86 teleconsultations, 3 medical theme discussions, 4 telenursing sessions, 1 teleodontology session and 7 international videoconferences) with the participation of 772 health professionals. The implemented model of Telehealth showed itself effective in reducing the necessity of relocating patients to only 24% of discussed cases, improving the resolution potential of the public health system. Simultaneously it has been observed a progressive rise in the participation of professionals in the clinical telesessions. INDICE/INDEX A MULTI-DIMENSION METHODOLOGY FOR ASSESSING, EVALUATING AND COMPARING THE TELEHEALTH PROJECTS Fregonara, M. (1); Borghi, G. (2) (1) Azienda Sanitaria Locale Provincia di Milano 3, Monza (Milan), Italy (2) Health General Direction - Lombardy Region, Milan, Italy The telehealth projects receive mainly public funding, therefore government agencies make careful economic assessment and impact analysis of the investment expenditures and results. The Cost/Benefit Analysis (CBA) investigates all the possible resources and estimated effects derived by the introduction of technological innovations. The comparison between resources (costs) and results (benefits) is used for estimating the impact of telehealth projects, in order to choice the project offering more net benefits among different solutions. The main goal of the proposed method, based on six steps, is to overcome the CBA limits enlarging its analysis parameters with a multi-dimensions approach of assessing, evaluating, selecting and comparing the costs, benefits and social impacts of telehealth projects in order to take a decision about its outputs, resources and outcome. The first step identifies and classifies all the information on the main assessment parameters for the project analysis: costs, profits and impacts. The second step splits all the resources within the project implementation phases: design, realisation, activation, utilisation and divestment. The third step collects the data within the aggregated macro-items in order to obtain an abstraction level, but keeping a sufficient detail. The fourth step combines and classifies the aggregated macro-items into the different project phases to obtain a better ranking of the assessment parameters. The fifth step estimates the balance of all the amount (costs and profits) and the outcomes (impacts) for each project phases, in order to allow a specific or global evaluation. The last step defines the metrics to support the decision about financing the project, based on the previous steps. This approach aims at estimating the global increase of health state through the value of all the resources, costs, benefits and outcomes, because all the main actors (patients, their family, physicians and service organisations) attribute different values to these parameters. The methodology is also focused on the project impact, measured through the evaluation of costs and benefits, the assessment of possible effects, included the intangible or social benefits for people and the direct/indirect influences on the National Health Service budget. The method acquires all the information needed to inquire into all the complex impacts of telehealth projects from different perspectives: patients' quality of life; care cost saving; modification of treatments; equipment and supply costs; time of actors; improper admissions or examinations. The method compares telehealth projects in order to both “ex ante” (economic feasibility and realisation costs) and “ex post” (benefits and general costs) or both “traditional” and “telematics” processes, evaluates different workflows or solutions, analyses among alternatives with potentially diverse global benefits, assesses different organisation and management of health centres. The method, tested in telecare, will fit also in different sectors of health: teleeducation, telenursing, etc. Up to now, we are developing a software tool for the evaluation of telehealth projects through the proposed methodology, acquiring all the information needed to analyse a project from all the different perspectives. INDICE/INDEX A SLIGHT SIGHT ON FRENCH TELEMEDICINE ADVENTURE : TWO CONCRETE TELEMEDECINE APPLICATIONS Petitet, A. - MD (AP) CATEL , ISfTeH board member, CardioGap - Le Thor - France FOREWORDS. On august , 13th , 2004 a very important event took place in France: for the first time , the word: telemedicine was legaly inscribed in a french law . That's means from now , telemedicine actions move from "hunting stories" to pragmatic application tracks. This communication reports two applications : - 1. an international acute cardiac ischemia rescue network (before the law). - 2. an emergency network in a whole french district (after the law). !- An international acute cardiac ischemia rescue network. In 1998 , sanitary evacuations statistics showned to a french oil company medical department for expatried workers the second place of suspected acute myocardial infarction. The head of this medical departement decided to improve the real documentation on time to better know the severity and the potential level of emergency . It was decided to equip each site for exploitation and/or prospection with a ECG recorder-transmitter all over the world . 40 devices were active . The reception medical station for reading , analysis and decision was first a North America call center , then a french emergency hospital station . The network was working during 7 years . There were 35 "medical" calls : in 17 , ECG electric changes were in favor of acute myocardial infarction or early ischemia ; in 18 , no real proof of electric cardiac disorders . So the conclusion was:(1) in 17 , the quick decision to treat then to transport patients to a well equiped hospital concerning cardiac emergencies improve dramatically the quality of care and first of all , the recovering ,(2) avoidance of unusufull sanitary evacuation in 18 with a decreasing financial charge for this post. Today , after this positive experience , the company initiate local and regional connections by telemedecine between its workers groups and agreed hospital and clinics. !- An emergency network in a whole french district. The french emergency organisation is one of the best worlwide . It is based on SAMU/SMUR on one hand , Firemen on the other hand. The main principle is to have a medical inside the emergency car . But , several factors and also a large new pannel of types of transport have changed the today conditions. In addition , more and more , the medical teams out and in hospital need to work closely together and to use for that the same objective documentation in real time. There are 98 administrative french districts . One of them , an average one , Vaucluse was chosen to be equiped by a multiparametric monitor able to transmit continously data from the emergency car to the hospital station. 14 emergency cars are equiped . The device is able to collect biomedical parameters as ECG 12, Sp0²,NIBP,Respiration, Capno and also to provide a very complete electronic and evolutive patient dossier all over the transportation. The sensor module and the tablet PC inside the car are linked by bluetooth (no cables) . The tablet PC ,where all the data are collected with e-PR, is linked with the hospital station by GPRS . Inside hospital , the regulation station might be connected with a terminal in the CCU for instance. All the screens of this netwoork show the same documentation on the same time. More , there is a two ways messagerie for exchanges between the mobil team and the hospital one. Numerous advantages are done (1) no delay to drive the patient to the well adapted hospital reception ,(2) interoperability between mobil emergency team and hospital medical team , (3)help to the primary first aid or para-medics team to improve the care under the medical management,(4) costs effectivity by avoidance of wrong transportations,(5) better and more accurate hospital reception ,(6) electronic objective documentation to be stored for forward expectation , (7) a perfect common transmission tool between SAMU/SMUR and Firemen . This is a pure concrete demonstration of role of telemedicine in a daily sensible practice. INDICE/INDEX A SOCIAL PERSPECTIVE APPROACH ON TELEMEDICINE FOR LAND MINES VICTIMS IN COLOMBIA Vélez Beltrán, J.A. and Navarro Newball, A.A. Colombian Telemedicine Centre, Cali-Colombia KEYWORDS. Telemedicine, Land mines, Rehabilitation, Emergency, Evacuation, BACKGROUND. The Colombian territory has been seeded with more than 100.000 land mines and, 5.688 accidents and incidents and 3.263 victims had been registered in 94% of the territory. OBJECTIVE. The objective of this work is to create and to validate a set of web-based interactive tools to support assistance of land mines' victims and health care professionals in Colombia. METHODS. The Web-based environment for land mines' victims support follows an interdisciplinary and inter-institutional work and an object oriented software methodology. Actually, the prototype of the environment is under a technical validation which includes performance tests and surveys. RESULTS. At the moment there are three prototype web environments. The emergency attention environment facilitates the communication between health personnel attending the victim and specialists in trauma. The rehabilitation environment allows the remote supervision of the patient during the healing process, decreasing the number of required displacements. The characterisation environment allows the search and selection of trauma specialist. Also, a preliminary validation took place. DISCUSSION. Even though the web based interactive tools show a high level of interactivity, they must be enhanced in order to make them friendlier. The access to the land mine victim's support environment is easy as long as there is an Internet connection. An educational cycle including a web based expert decision support system (WEDS), a planning instrument, a video transmission and a simulator can be extended in order to complement the tools. The deployment of the proposed environment will cause a great social impact. [email protected] [email protected] INDICE/INDEX A TELERADIOLOGIA SEM O PACS. O PROJETO INTERINSTITUCIONAL ENTRE CENTRO DE ENSINO NACIONAIS EM RADIOLOGIA PEDIÁTRICA. Monteiro, A. Faculdade de Ciências Médicas da UERJ. A Faculdade de Ciências Médicas, entre os Projetos em Telemedicina, tem desenvolvido Projetos de Teleintegração com outros centros de ensino, nacionais e internacionais, com o objetivo de aperfeiçoamento, ensino, pesquisa e assistência. Neste âmbito acadêmico destaca-se o Projeto Interinstitucional em Radiologia Pediátrica pelo seu pioneirimo nesta linha de pesquisa e assistência e, pela sua relevância no atendimento desta população de crianças. Utilizando sistemas de videoconferências, com conexões pela Rede de Internet via RNP, e também por ISDN, o Projeto já agrega, até o presente, cinco pontos no nosso país. Na metodologia de troca e envio de imagens têm-se adotado sistemas simples, tais como o digitalizador de imagens, o progama Microsoft PowerPoint e o próprio uso do negatoscópio, online. O propóstito desta forma simplificada de troca de imagens pode ser resumido como um facilitador do processo de inclusão entre diferentes centros de ensino. O público alvo tem sido de alunos da graduação e da pós-graduação, lato e stricto-senso, além de médicos e professores. O objetivo pricipal deste projeto é capacitar, de forma atualizada, o médico-radiologista, e permitir a integração em projetos de pesquisa multicêntricos. Experiência do INCOR no desenvolvimento, implantação e manutenção do PACS Gutierrez, M.A. Serviço de Informática, Insituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP. O Instituto do Coração (InCor) tem envidado esforços para integrar todas as informações clínicas dentro da Instituição. Nos últimos anos o InCor implementou com sucesso um sistema para transmissão, arquivamento, recuperação, processamento e visualização de Imagens Médicas (PACS-InCor) e um Sistema de Informações Hospitalares (SI3) que armazena as informações administrativas e clínicas. A integração desses subsistemas forma o Prontuário Eletrônico do Paciente (PEP).Institutos é também uma questão muito relevante. INDICE/INDEX ACTIVITIES OF THE TELEDENTISTRY CENTER AT SACRED HEART UNIVERSITY Sgavioli, C.A.P.P. 1; Veronezi, M.C.1.; Marta, S.N. 1; Carvalho, I.M.M.1; Soares, S.1; Melare, D.1; Sequeira, E.2; Chao L.W.2 (1) Sacred Heart University, Bauru, São Paulo, Brazil. (2) Discipline of Telemedicine, Medical School, University of São Paulo, São Paulo, Brazil. The presence of new technologies requires new positions in the process of learning and teaching. Attempting to transform regular classes in a continuous process of information, communication and investigation, where the knowledge can be built through the balance of individual and group work, between professor coordinator supporter and the active participation of students, in this way Teledentistry was introduced at USC. The current data available from ENADE on the students' access to technology and number of professionals registered in the Federal Dental Council, as well as the amount of dental courses existing in Brazil, show the possibility of an increase in the activities of Teledentistry, increasing the space and time in the access to permanent formation and education of all. This opens the possibility of the University to assist dental professionals working in places distant from the learning institutions and searching for professional upgrade or a second professional opinion in diagnosis and treatment planning. The Dental Course of USC keeps a technical-scientific accord with the Discipline of Telemedicine of FMUSP for utilization of the website “Medical Digital Station” (www.estacaodigitalmedica.com.br). Online courses by the “Cybertutor” Teleeducation environment; the “Virtual Ambulatory” for Dentistry and also the creation of Cd-Roms within the Virtual Man Project were developed. Undergraduate and graduate dental students are using the whole material produced so fat in the learning activities. The Teledentistry at USC was developed because of the ability of the group of people involved to make plans real, starting with ambitious dreams, claiming to reach the entire community interested in the growth and education in Dentistry. INDICE/INDEX ANALYSIS OF PARAMETERS OF MANAGEMENT IN THE PROFESSIONAL QUALIFICATION DIRECTED TO THE TECHNOLOGICAL INNOVATION IN HEALTH THROUGH THE USE OF THE TELEMEDICINE Borges, C. L. Digital Radiology Observer - ORD São Paulo / SP - Brazil INTRODUCTION. The objective of this work is the analysis of management parameters to be used in the professional qualification directed to the technological innovation in Health through the use of resources of Telemedicine. This exercise resulted in the construction of a pilot course aiming to the specialized formation in area of administrative and operational management of projects that involve digital technology in departments of Radiology, to be offered by the Radiology Institute / USP in partnership with the Radiology Department / UPenn, counting on the contribution in services of Telemedicine Discipline / School of Medicine / USP. METHODOLOGY. The study consists of the analysis of the relevancy and interrelation of values listed as necessary to the elaboration and implementation of the course, as much in the basic infrastructure for remote communication as in the logical sequence of knowledge absorption directed to the formation specialized in this sector. Functional and administrative infrastructure aspects will be analyzed in the use of resources of Telemedicine for remote communication with different types of data (text, image and voice) guided to the professional qualification. In the question of systematization of the knowledge absorption directed to the technological innovation, parameters of efficiency will be evaluated through use of relationary practical of the study divided in 06 sequential discipline modules elaborated. RESULTS AND CONCLUSION. The waited results of the analysis, when the course on field, suggest the construction of a basic model of management for use of Telemedicine in professional qualification directed to technological innovation in Health. INDICE/INDEX APRENDIZAGEM AUXILIADA POR COMPUTADOR EM OFTALMOLOGIA PARA PROFISSIONAIS DA SAÚDE NÃOESPECIALIZADOS Grottone, G., Pisa, I.T., Lopes, P.R.L., Barsottini, C.G.N., Schor, P., Sigulem, D. Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil INTRODUÇÃO. A oftalmologia é uma especialidade de difícil aprendizado para outros profissionais de saúde fora o médico-oftalmologista. Novos métodos de ensino, baseados em auxílio informatizado, podem produzir melhores resultados nesta tarefa. OBJETIVO. O objetivo deste trabalho é desenvolver e validar um novo protocolo direcionado à consulta oftalmológica por profissionais da saúde, utilizando elementos computacionais e multimídia para auxiliar no ensino. MÉTODOS. Baseado em uma lista de sinais e sintomas em oftalmologia, um novo protocolo foi desenvolvido tomando como base a experiência obtida através de 10 alunos de medicina, que utilizaram diretrizes oftalmológicas préestabelecidas, testando suas dificuldades de aprendizagem. Antes do atendimento com pacientes, foram reunidos e instruídos por um supervisor quanto ao funcionamento de cada instrumento a ser utilizado na consulta bem como seus possíveis resultados. Para cada bloco de informações, uma nota entre 1 e 10 foi atribuída ao grau de dificuldade para fazer o exame e interpretar os resultados gerados. RESULTADOS. Ao final de dois meses, o protocolo final foi apresentado demonstrando suficiente informação para o profissional de saúde ter uma ferramenta para decidir quais os pacientes que necessitavam de atenção imediata de um especialista em oftalmologia. CONCLUSÃO. Este é o primeiro passo para produzir um programa de computador com a meta de poupar recurso em saúde, distribuindo conhecimentos básicos e habilidades sobre cada especialidade médica. Isso é de extrema importância quando pensamos em países em desenvolvimento, onde o acesso ao médico especialista frequentemente é dificultado por barreiras sócio-econômicas e geográficas. Apresentação como POSTER INDICE/INDEX ASSESSMENT OF VIDEOCONFERENCE QUALITY FOR HEALTH DISCUSSIONS BETWEEN LONG DISTANCE HOSPITALS Campelo, VES; Pinheiro Neto, CD; Bento, RF; Wen, CL Faculty of Medicine, University of Sao Paulo INTRODUTION: The telemedicine system is a new way of medical practice. It provides tools for patients' data retrieval and image data communication between long distance hospitals on the information highway. Information technology is now becoming the most popular technology every fields should consider. To make telemedicine an effective medical practice it is essential to become an easy technology and principally to show good quality for data exchange. OBJECTIVES: to assess the quality of videoconference in case discussions. METHODS: a short questionnaire was administered to 20 otolaryngologists (15 males/5 females) after two videoconferences between University of Sao Paulo and Rio de Janeiro State University at a IP (internet protocol) 384Kbps conection. There were 13 ENT residents, 5 post-graduating students and 2 Phd. RESULTS: 65% of the interviewees considered that the images were good and 70% answered that the audio was good. 75% said that image quality didn´t hinde case comprehension. 65% considered that videoconference is the best way to exchange experience between distant health groups, and 75% agree that it´s use will increase. 25% didn´t know that videoconferences could be done using internet. CONCLUSIONS: This telemedicine system showed its ability to improve the way of patient information presentation and to access patient medical records with good quality of image data communication. INDICE/INDEX AVALIAÇÃO DO PROGRAMA INTER-INSTITUCIONAL DE TELEMEDICINA DA PÓS-GRADUAÇÃO DE RADIOLOGIA DA UNIFESP, UFF, UERJ, USP 1 Lopes, P.R.L. ; Pisa, I.T.1; Ajzen, S.1; Santos, A.A.S 2; Gismondi, R.C.2 Monteiro, A.M.V.3; Machado, H.R.4; Ferreira, W.S. 4; Borges, C. L.5; Sigulem, D.1 1 Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2 Faculdade de Medicina - Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ, Brasil; 3 Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil; 4 Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil; 5 Observatório de Radiologia Digital (ORD), São Paulo, SP, Brasil INTRODUÇÃO. Programas de telemedicina inter-institucional podem acelerar a colaboração entre grupos afins se em seu planejamento são considerados aspectos sobre o objetivo dos parceiros, atividades práticas a serem realizadas e parâmetros de avaliação pré-estabelecidos, entre outros. OBJETIVO. Este trabalho tem como objetivo descrever um modelo de parametrização para avaliação na colaboração médica em programas de telemedicina inter-institucionais. METODOLOGIA. Considera-se o uso dos recursos de comunicação remota na participação quinzenal de estudos de caso e qualificações de tese entre os setores de pós-graduação das instituições supra citadas. Pretende-se implementar uma métrica de avaliação para levantar resultados relevantes sobre a qualidade da colaboração médica realizada, considerando efetividade, segurança, praticidade e utilidade. Para seguridade serão avaliados aspectos sobre a qualidade da imagem e câmera, resolução espacial e cores, compressão, imagens necessárias no processo, largura de banda e treinamento adequados. Para praticidade serão avaliados aspectos sobre a organização do serviço, disponibilidade dos equipamentos, competência para operação, financiamento e aspectos legais. Quanto à utilidade serão considerados a melhoria da qualidade do serviço, melhoria do bem-estar da população e custo-efetividade do programa proposto. RESULTADOS. Os resultados preliminares demonstram a importância de realizar uma avaliação crítica da conectividade dos parceiros antes de estabelecer os recursos que serão efetivamente empregados no programa. CONCLUSÃO. A partir desse modelo de avaliação torna-se possível desenvolver um programa inter-institucional de telemedicina com parâmetros para demonstrar a viabilidade financeira do projeto e sua efetividade em relação ao processo em saúde em questão. INDICE/INDEX AVALIAÇÃO DO SITE ESCALA DE PESSOAL DE ENFERMAGEM Juliani, M.C.M.*; Kurcgant, P.** Faculdade De Medicina Da Unesp Botucatu/ Sp/ Br / Usp/ Sp INTRODUÇÃO. O estudo, parte da tese de doutorado da autora, aborda o resultado de avaliação de um site sobre escala de pessoal de enfermagem, tema relevante no gerenciamento de recursos humanos de enfermagem, em especial nas instituições de saúde que funcionam 24 horas. Cada tecnologia modifica dimensões da nossa inter-relação com o mundo, da percepção da realidade, da interação com o tempo e o espaço2. OBJETIVO. Validar junto a experts da área de administração em enfermagem e alunos de graduação o conteúdo do site desenvolvido. METODOLOGIA. Uma vez produzido o site, a pesquisadora fez contato com docentes das escolas públicas de graduação em Enfermagem do estado de São Paulo que ministravam aulas na disciplina de Administração em Enfermagem, portanto experts no tema do site e também com alunos de graduação. A avaliação foi feita por meio de formulário eletrônico no próprio site no final do ano 2002 e início de 2003. RESULTADOS. Na somatória dos itens excelente e satisfatório, os seguintes percentuais de aprovação: Design das Telas 88,45%, Velocidade de Navegação 96.15%, Legislação (Aplicabilidade Profissão) 90.47%, Legislação (Aplicabilidade Ensino) 95,23%, sendo a média de aprovação para todos os itens avaliados (somando os critérios excelente e satisfatório) de 85%. CONSIDERAÇÕES FINAIS. Na interatividade deve-se considerar aspectos cognitivos, emocionais e tecnológicos da aprendizagem1. O site foi considerado de utilidade tanto para o ensino como para a profissão de enfermagem e a avaliação significativa já que envolveu 30% dos docentes das escolas públicas do estado de São Paulo, considerados experts na área específica estudada. BIBLIOGRAFIA. 1. Fainholc B. La tutoria en la educación a distancia: problemas y recomendaciones. Tec Educ 1997; 25 (136/137): 39-41. 2. Moran JM. Novas tecnologias e o reencantamento do mundo. Tec Educ 1995; 23 (126): 24-6. INDICE/INDEX AVALIAÇÃO DO USO DO CYBERTUTOR COMO FERRAMENTA DE ENSINO PARA ALUNOS DE GRADUAÇÃO EM ODONTOLOGIA Legramandi, D.B.1; Veronezi, M.C.1; Pegoraro, C.N. 1; Domingues, L.A.1; Carvalho, R. S. 1; Dalpino, N. R. S. 1, Sequeira, E. 2; Atta, M. T.1; Sgavioli, C.A.P.P. 1 1- Universidade do Sagrado Coração Bauru S.P. Brasil. 2- Disciplina de Telemedicina São Paulo S.P. Brasil. O curso de Odontologia da Universidade do Sagrado Coração em acordo com a Disciplina de Telemedicina/FMUSP-SP desenvolveu cursos online. As instituições mantêm cooperação tecnocientifica para o conteúdo Odontológico da Estação Digital Médica baseada na internet (www.estacaodigitalmedica.com.br), site que contém um ambiente de teleducação Cybertutor. Este tutor eletrônico é uma ferramenta interativa que permite o aprendizado de conceitos teóricos num modelo construtivista estimulando o desenvolvimento da cognição, capacidade de expressão e síntese. Composto por um ambiente que contém fórum de debates, tutorização on line, permite ao aluno participação com maior discussão sobre o assunto e possibilita a verificação do aprendizado. Na disciplina de Dentística, o curso no Cybertutor, Nomenclatura e Classificação das Cavidades, foi utilizado com vinte alunos do segundo ano de graduação em Odontologia para um primeiro contato com o conteúdo a ser desenvolvido. Este trabalho apresenta a avaliação dos alunos sobre o método interativo empregado, assim como, a apreensão de conhecimentos dos mesmos. Metade dos alunos teve um primeiro contato com a matéria pelo Cybertutor e a outra metade, em aula expositiva. Na semana seguinte, as turmas se inverteram, portanto todos os alunos tiveram contato com o conteúdo pelos dois métodos. Para avaliar a apreensão do conhecimento, os alunos passaram por uma avaliação dissertativa após cada etapa. Para avaliar o método empregado responderam a um questionário elaborado sobre o assunto. Resultados obtidos a partir da avaliação aplicada mostraram que com relação à apreensão do conteúdo, os dois métodos não apresentaram diferenças significantes. Entretanto, o tempo gasto para que os alunos entendessem o conteúdo sob a forma de aula tradicional foi consideravelmente menor para o grupo que utilizou o Cybertutor previamente à aula teórica. A avaliação dos alunos sobre o método mostrou que todos o aprovaram como complemento da aula expositiva. UTILIZATION OF THE CYBERTUTOR AS A TEACHING TOOL FOR UNDERGRADUATE DENTAL STUDENTS Legramandi, D.B.1; Veronezi, M.C.1; Pegoraro, C.N. 1; Domingues, L.A.1; Carvalho, R. S. 1; Dalpino, N. R. S. 1, Sequeira, E. 2; Atta, M. T.1; Sgavioli, C.A.P.P. 1 1- Sacred Heart University Bauru/SP Brazil. 2- Discipline of Telemedicine São Paulo/SP Brazil. The Dental School of Sacred Heart University, in collaboration with the Discipline of Telemedicine of FMUSP-SP developed online courses.The institutions keep a technical-scientific collaboration for the dental contents of the internet-based Medical Digitalstation (www.estacaodigitalmedica.com.br) ,a website that contains the Teleeducation environment Cybertutor.This electronic tutorial is an interactive tool that allows learning of theoretical concepts in a constructive model, stimulating the development of cognition, ability of expression and synthesis. Composed of an environment with a forum of debates, and online tutorial, it allows participation of the student with discussion on the subject and verification of learning. In the discipline of Restorative Dentistry, the course on Cybertutor on the Nomenclature and Classification of Cavities was used by twenty students of the second year of dental school for a first contact with the content to be developed. This paper presents the evaluation of the students on the interactive method employed, as well as their acquisition of knowledge. Half of the students had the first contact with the subject by the Cybertutor and the other half in an expositive class. In the following week, the groups were inverted, and thus all students had contact with the content by both methods. To evaluate the acquisition of knowledge, the students underwent an evaluation after each step. To evaluate the method, they answered a questionnaire on the issue. The results achieved in this evaluation revealed that, concerning the acquisition of knowledge, both methods did not present significant differences. However, the time spent by the students to understand the content by the traditional method was considerably shorter for the group using the Cybertutor before the theoretical lesson. The evaluation of students on the method demonstrated that all approved it as a complement to the class. INDICE/INDEX BUILDING AN INTERNATIONAL TELEHEALTH PROGRAM: OVERCOMING BARRIERS INTERNALLY AND EXTERNALLY Nason, A.M. Johns Hopkins Medicine International, Baltimore, Maryland, USA Johns Hopkins laboratories, classrooms and clinical units are centers of learning for thousands of physicians, students and health professionals. Johns Hopkins Medicine International (JHI) works with international institutions, physicians and leaders to fulfill their needs for education and training in their particular area of expertise by utilizing the subject matter experts from one of the United States' premier academic institutions Since 2001, JHI has taken steps to fulfilling this goal through the uses of both 'hi-tech' and 'low-tech' telecommunications and telemedicine technologies. With the changes in the world at that time, JHI felt it was critical to remain local in a community without physically being present. It is the philosophy of the JHI telehealth program that that the ability to influence many is more powerful than treating one. JHI and the Hopkins Office of Telemedicine have supported several international initiatives of knowledge sharing through video conferencing and e-learning formats. And while successful, all programs, regardless of location, socio-economic status and culture, are faced with its pitfalls and challenges. This presentation will outline the successes of the JHI telehealth programs (video education programs, telemedicine consultations), the results of our successes (development of the Center for Clinical Global Health Education and Johns Hopkins Medicine-Interactive), and the pitfalls we regularly run into when establishing these programs. INDICE/INDEX BUSINESS PLAN AND OPERATIONAL PROTOCOLS TO ENSURE SUSTAINIBILITY AND ACCEPTANCE OF TELETRAUMA PROGRAM 1 2,3 1 2 2 Judkins D.; Latifi R.; Whalen E.; Williams M.D.; Porter J.M. 1 University Medical Center, 2Department of Surgery, Trauma and Critical, the University of Arizona, and 3Arizona Telemedicine Program, Tucson, Arizona, U.S.A. BACKGROUND. Technological advances and experience gained with routine telemedicine services and networks have made possible implementation of the teletrauma as an integral part of modern trauma care. However, although this is an optimal solution for providing trauma expertise to a remote location for trauma resuscitation, there is a concern of sustainability of such programs and acceptance by hospitals and healthcare providers in their daily practice. METHODS. A successful program requires careful planning, a highlysophisticated telemedicine network, technical support on a 24 hour basis, and a well-developed business plan, with a detailed operational procedure manual. This document needs to be created with input from each member of the multidisciplinary team, as it represents a new paradigm providing telemedicine services for trauma and emergency care. RESULTS. To insure program sustainability, we created an operational document using a business model that includes an executive summary, vision and objectives, products, current and future services, and step-bystep operations. This was done based on market analysis, developmental strategy, and predictions of cost- effectiveness of the program. The operational procedures consist of how to operate the telemedicine system, how to initiate and complete teletrauma resuscitation based on ATLS protocols, trouble-shooting and avoiding system failures, staffing and scheduling, documentation and maintaining a database. CONCLUSIONS. A successful teletrauma program requires a good business plan, defined operational procedures, and input and acceptance by all stakeholders. INDICE/INDEX CEDECEM: A TELEMEDICINE PROGRAM APPLIED TO DISTANCE MEDICAL EDUCATION AND SECOND OPINION CONSULTATION IN INFECTIOUS DISEASES AND PERINATOLOGY IN ARGENTINA. Debbag R., Enrique S., Cassetti I., Vazquez L., Vujacich C., García F., Sarkis C., Carniglia L., Prudent L., Stamboulian D. FUNCEI, Buenos Aires, Argentina. BACKGROUND: CEDECEM is a Telemedicine program in Argentina providing medical education courses (ME) and second opinion consultations (SOC) in Infectious Diseases and Perinatology to public hospitals (PH). METHODS: CEDECEM was started in April 2002. Each beneficiary hospital received a computer and Internet connection. A specially designed secure web site (www.funcei.org.ar/cedecem) gives health care professionals (HCP) access to ME and SOC. Courses deal with Infectious Diseases in Adults (A), Pediatrics (P) and Perinatalogy (Pe) for physicians and Hospital Infection Control (HIC) for nurses. Each course lasts 2 years, arranged in 8 modules. HCPs also receive a printed manual, on site tutorial meetings and multiple choice online evaluations per module. SOC have no time limit and they are only answered online. RESULTS: Up 01/31/05, 6,223 HCP from 25 PH and 3 medical stations in the Argentine Antarctic Territory received ME and access to SOC (3,144 Nurses and 3.079 Physicians: A 1,356, P 873 and Pe 619). 72% of the physicians and 85% of the nurses were satisfactory evaluated. 2,089 SOC were answered (A 862; P 718, Pe 509) in 42 hours average time. The most frequent SOC were related to clinical and laboratory diagnostic problems, use of antibiotics and epidemiological aspects. CONCLUSIONS: CEDECEM has created a network for scientific exchange among HCP from PH in Argentina, who usually have difficulties to access ME and SOC mainly due to distance and economic factors. This telemedicine model with over 3 years' experience in Argentina may be replicated in other countries, particularly in Latin America. INDICE/INDEX CREATION OF THE TELEMEDICINE LEAGUE OF THE FACULTY OF MEDICINE OF THE UNIVERSITY OF SÃO PAULO. Rocha GZ, Daré Junior S, Azevedo R, Fernandes GCVR, Chao LW Discipline of Telemedicine of the Faculty of Medicine of the University of São Paulo. Students of the Faculty of Medicine of the University of São Paulo (FMUSP) have a long tradition in organizing academic leagues of extension of university services to health care. The Telemedicine Discipline of the FMUSP wanted to extend its activities to the undergraduates of the university. We have proposed this through the creation of an interdisciplinary academic league. In order to do that we gave an introductory course about the scene and the concepts of telemedicine and the results of the practice of telemedicine in Brazil; we included an electronic test and a personal interview. A proposed Statute of the Telemedicine League was the source for the description of the organization and of the functioning of the league. The introductory course was ministered by 12 speakers during 7 expositive classes, a workshop and a debate. The attendance was composed of students of engineering (1), dentistry (1), medicine (14), biomedical informatics (16), nursing (12) and physiotherapy (1) and of 2 medical doctors and 4 lecturers. Of the 37 attendants 14 took the electronic test. The league was formed with 16 graduate students: medicine (8), nursing (7) and physiotherapy (1). The league was organized in 4 groups of tasks, in monthly turns: tele-education, tele-assistance, iconography and teleconference and a permanent group for the application of tele-assistance in social university extension. CONCLUSION: the first academic league of telemedicine in Brazil was formed; the selection through electronic tests was adequate. This first step is characterized by interest only graduate students of the health in integrating this league. INDICE/INDEX DESENVOLVIMENTO DE CD ROM EM IMUNIZAÇOES Juliani, C.M.C.M.*; Godoy, I*; Spiri, W.C.*; Diniz, C.G.P.**; Alvin, F. B.**; Togashi, G.B.**; Alencar, A.** Faculdade De Medicina Da Unesp Botucatu/ Sp/ Br INTRODUÇÃO. O tema imunização é relevante na formação do profissional de saúde. O produto CD ROM em Imunizações foi desenvovido por um grupo de alunos de graduação em enfermagem da Faculdade de Medicina da UNESP em conjunto com três docentes que orientaram a organização e operacionalização do trabalho. Embora a tecnologia seja apenas um aspecto do processo pedagógico, seu desenvolvimento torna-se apropriado ao atual estágio de desenvolvimento tecnológico. Mais que a tecnologia, o que facilita o processo de ensino-aprendizagem é a comunicação autêntica do professor, e estabelecimento de relações de confiança com os alunos2. OBJETIVO. oferecer recurso tecnológico-pedagógico com conhecimentos técnico - científicos dos imunobiológicos. METODOLOGIA. As etapas de desenvolvimento passou pela escolha dos conteúdos, desenho de mapas conceituais, produção das imagens, que foram produzidas pelo grupo através de fotografia digital realizadas no serviço de saúde no momento de realização das ações de imunização com apoio do Núcleo de Educação a Distância (Nead) da FMB Unesp, edição e revisão do CD ROM para publicação. RESULTADOS. O produto final CD ROM permite difusão do conhecimento, oportunidade de acesso em diversos locais, possibilidade da utilização do recurso na educação a distância, clareza na transmissão da informação dado que as técnicas, procedimentos, vacinas e insumos foram fotografados in loco nas situações reais de atendimento no serviço. CONSIDERAÇÕES FINAIS. A formação dos profissionais necessita incorporar todos os avanços científicos e tecnológicos. Além da instrumentalização técnica, é necessário o compromisso ético-político de socializar o conhecimento e as informações na tentativa de tornar o mundo humano1. BIBLIOGRAFIA. 1. Ferreira NSC. Tecnologia educacional e o profissional no Brasil: sua formação e a possibilidade de uma cultura humana. Tec Educ 1998; 26 (141): 26-9. 2. Moran JM. Mudar a forma de aprender e ensinar com a Internet. In: Ministério da Educação (BR). Secretaria de Educação à Distância. Salto para o futuro: TV e informática na educação. Brasília (DF); 1998. INDICE/INDEX DISPONIBILIZAÇÃO DE GUIAS DE CONDUTA E DIAGNÓSTICO BASEADOS EM FLUXOGRAMAS DE OFTALMOLOGIA ATRAVÉS DE DISPOSITIVOS MÓVEIS E TECNOLOGIA WEB Pinto, V. C.; Pisa, I. T.; Lopes, P.R.L.; Barsottini, C.N.; Schor, P. Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil INTRODUÇÃO. O uso de guias de conduta tem demonstrado nos últimos anos de vital importância para organizar e efetivar maior qualidade nos processos de assistência em saúde. Em particular, guias de conduta se mostram úteis no auxílio da prática médica e no diagnóstico para clínicos gerais e generalistas em oftalmologia. OBJETIVO. Esse trabalho tem como objetivo disponibilizar guias de conduta e diagnóstico baseadas em fluxogramas de oftalmologia direcionadas a clínicos gerais e generalistas de modo a categorizar doenças a partir de sinais e sintomas. METODOLOGIA. Pretende-se desenvolver uma solução tecnológica para diagnostico médico através da usabilidade da informação categorizada em situações reais e simulada por meio do uso de guias de condutas. Esses guias serão ofertados para uso através de dispositivos móveis e plataforma web. Serão realizadas pesquisas no Departamento de Oftalmologia da UNIFESP a partir de fluxogramas pré-estabelecidos na literatura e opinião de especialistas. RESULTADOS. A avaliação será realizada de modo quantitativo através de testes paramétricos e qualitativos usando o padrão NBR/ISO 9241 de qualidade, que esclarece os benefícios de medir usabilidade em termos de desempenho e satisfação do usuário. Finalmente espera-se obter com esta solução uma medida efetiva da melhoria na atenção a saúde. CONCLUSÃO. Espera-se contribuir com uma solução tecnológica avaliada quantitativamente e qualitativamente que auxilie clínicos gerais e generalistas na utilização de guias de conduta em oftalmologia na assistência médica. INDICE/INDEX EDUCAÇÃO A DISTÂNCIA UMA PROPOSTA DE ATUALIZAÇÃO PERMANENTE EM MASTOLOGIA EXPERIÊNCIA COM BIÓPSIA DO LINFONODO SENTINELA Kelmer, S.; Fonseca, L.M. UFRJ, FM Departamento de Radiologia Rio de Janeiro Brasil INTRODUÇÃO. Projeto de Mestrado - Criação, aplicação e avaliação do curso de atualização em mastologia na técnica da Biópsia do Linfonodo Sentinela no Câncer de Mama , na modalidade educação a distância mediada pela internet.Trata-se de uma técnica simples e recente, reconhecida pela sociedade médica internacional como imprescindível, mas ainda pouco difundida no nosso meio. Este curso terá um público-alvo composto por médicos-especialistas em Medicina Nuclear, Radiologistas, Ginecologistas, Mastologistas e Cirurgiões Oncológicos. O curso estará sendo ministrado pela Internet nos meses de outubro e novembro(2005), a avaliação será composta de uma prova presencial a ser realizada em dezembro/2005 na UFRJ. Aos alunos que obtiverem rendimento satisfatório será oferecida uma experiência prática, estes poderão acompanhar um procedimento de detecção e retirada do Linfonodo Sentinela em cirurgia de câncer de mama no Hospital Clementino Fraga Filho (UFRJ) ou no Hospital Fernandes Figueira. MÉTODOS. Para a elaboração do conteúdo do curso foi formada uma parceria com a EAD/ENSP-FIOCRUZ , apropriando o conteúdo a didática da modalidade a distância. Foi formada uma parceria com uma empresa privada do setor de informática que vem fornecendo equipe de webdesigner, ferramentas tecnológicas (Ambiente Virtual de Aprendizado) apropriadas para o aprendizado interativo via Internet e suporte de rede. A divulgação e acreditação do curso serão realizados pela Sociedade Brasileira de Mastologia.RESULTADOS. O curso será avaliado por diversas óticas: pelo rendimento acadêmico dos alunos na prova presencial; a análise das dificuldades e das soluções encontradas para a transformação digital do conteúdo do curso, sobre o aspecto didático-pedagógico da modalidade à distância, da implementação e do decorrer do curso propriamente dito na Internet. CONCLUSÕES. Espera-se contribuir com este piloto para a divulgação da eficácia da educação médica permanente via Internet. Email para contato: [email protected] INDICE/INDEX EDUCAÇÃO EM SERVIÇO POR VIDEOCONFERÊNCIA Godoy, S.; Mendes, I.A.C.; Nogueira, M.S. Escola de Enfermagem de Ribeirão Preto-USP Realizou-se um treinamento sobre o conteúdo de administração de injetáveis pela via intramuscular na região ventroglútea entre auxiliares de enfermagem de um hospital escola do interior do estado de São Paulo. Teve como objetivo incentivar a utilização da região citada. Utilizou-se tecnologia de videoconferência para interligar um laboratório de ensino de uma escola de enfermagem estadual ao referido hospital. Foram ministradas aulas sobre o conteúdo utilizando-se a referida tecnologia e realizado treinamento em situação simulada. Os 32 auxiliares de enfermagem foram avaliados quanto a aquisição de habilidade intelectual e motora, bem como avaliaram a utilização da videoconferência como ferramenta para o ensino em serviço. Os resultados apontam que a maioria dos auxiliares de enfermagem obtiveram bom desempenho na realização do procedimento em situação simulada. A videoconferência se mostrou um bom meio para a realização de educação em serviço. Os participantes do estudo sugeriram ainda que para os treinamentos futuros sejam disponibilizados materiais para apoio ao aprendizado em outros formatos. INDICE/INDEX ESTABLISHMENT OF A PIONEER DIGITAL TELE-ECG SYSTEM IN SOUTHERN BRAZIL Sparenberg, A.L.F.; Russomano, T.; Azevedo, D.F.G. Microgravity Laboratory/IPCT-PUCRS, Porto Alegre, RS, Brazil Medical Society of São Lourenço do Sul, RS, Brazil INTRODUCTION. A lack of medical specialists in remote areas of Brazil can delay the diagnosis and the adequate management of diseases. A pioneer Telemedicine Program was established in southern Brazil in the area of cardiology (Digital Tele-ECG System, DES). METHOD. DES allows electronic data transmission to and interpretation by a remote cardiologist. An urban and a rural hospital in Sao Lourenco do Sul city and an outpatient unit in Turucu city employed the DES in Jan 2000, Jan 2001 and June 2003, respectively. DES includes a digital ECG machine, standard computers, a modem connection, internet facilities, telecommunication software and fixed or mobile phones. RESULTS. A total of 1063 tele-ECGs were performed in the three locations in 1 year: 622 via online and 441 via e-health. The time between data transmission and analysis was 8.1 min and up to 24h for the online and ehealth tele-ECGs. 604 online tele-ECGs (97.1%) were performed at the urban hospital. The results showed that 71.2% (443 out of 622) of the online tele-ECGs presented important ECGs alterations, including 66 (14.9%) ECGs with acute signs of myocardial ischemia and 39 ECGs (8.8%) with S-T elevation myocardial infarction. CONCLUSION. The low cost of DES make it useful and appropriate for small cities and rural areas of developing countries where cardiologists and radiologists are not available for on-site consultation. DES has promoted a significant improvement in the acute management of patients in remote areas, with a consequent decrease in the morbidity and mortality rates from cardiovascular diseases. e-mail: [email protected] e-mail: [email protected] INDICE/INDEX ESTABLISHMENT OF A PIONEER TELE-X RAY SYSTEM IN SOUTHERN BRAZIL Sparenberg, A.L.F.; Russomano, T.; Hammes, E.; Abreu, I.M.; Szomorovszky, S.V.; Freitas, M.A.V.; Timm, R. Microgravity Laboratory/IPCT-PUCRS, Porto Alegre, RS, Brazil Medical Society of São Lourenço do Sul, RS, Brazil BACKGROUND. A lack of medical specialists in remote areas of Brazil can delay the diagnosis and the adequate management of several medical conditions. A pioneer Telemedicine Program has been started recently in southern Brazil in the area radiology (Tele-x ray or DEX) as an attempt to overcome this situation. METHODS. DEX includes an x-ray facility, a viewing box, a digital camera, standard computers, a 3:1 Mitchell algorithm compression protocol using the Easy Thumbnails software and Internet access. The system allows data to be recorded, transmitted and stored. A remote specialist performs the data analysis via either fixed or mobile phone, using specific telecommunication softwares and web based transmission. Results: Sixty chest x-rays were randomly selected at the urban and rural hospitals of Sao Lourenco do Sul for a preliminary evaluation of DEX. A remote radiologist of each health care unit received 30 chest x-rays via ehealth transmission for later analysis. The x-rays were transmitted via Internet after being compressed. Lung and heart variables were compared using the on-site and remote interpretation. There was an 81.7% agreement (n=49) between the on-site and remote interpretation. Only 27.3% (3 out of 11) of the misinterpreted x-rays were related to a lack of identification of pathological abnormalities. In eight remotely interpreted x-rays (72.7%) additional information regarding signs of cardiac and pulmonary alterations were found. CONCLUSION. The low cost, the high quality and the “user friendly” aspect of DEX make it appropriate for remote areas of developing countries where radiologists are unavailable. e-mail: [email protected] e-mail: [email protected] INDICE/INDEX ETAPAS DE IMPLEMENTAÇÃO DO PACS NA ÁREA MÉDICA Pereira, A. J. INRAD, Hospital das Clínicas da Faculdade de Medicina da USP. A instalação de um sistema PACS/RIS em uma instituição é muito mais que apenas a implantação de um sistema de informações, são necessárias várias etapas preliminares para a definição de vários processos e necessidades do departamento e da instituição. Antes de tudo, a implementação destes sistemas tratam-se de uma mudança de filosofia e fluxo de trabalho que pode impactar toda a instituição. A maneira que com que o sistema e implementado pode acarretar no completo fracasso do projeto, devendo, desta forma ser cuidadosamente planejado e estruturado, desta forma evitam-se imprevistos devido a super e sub dimensionamento da solução. Destacam-se também no projeto a importância de uma correta avaliação dos impactos tomando assim as medidas preventivas e corretivas adequadas, provendo aos usuários do sistema uma base de treinamento e suporte sólida e adequada as suas necessidades. INDICE/INDEX ETHICAL EVALUATION OF MEDICAL TELECONSULTATIONS PERFORMED BY THE BHTELEMED PROJECT Souza, C.; Alkmim, M.B.; SANTOS, AF.; Melo, M.C.; Silva, I.M.; Bossi, G.A.; e Santos, S.F. Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil; PRODABEL - Empresa de Informática e Informação do Município de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil. . INTRODUCTION. Different from modern medical science, which has been shaped by a strong ethical tradition, Telemedicine as a new activity has controversial ethical and legal aspects which need to be analysed and discussed. The Brazilian Federal Council of Medicine (CFM), through the resolutions 1643/2002 and 1639/2002 established ethical criteria for Telemedicine and digital medical records. However, considering the relevance of Telemedicine and its certain expansion, it is strongly recommended to carry out studies regarding ethical aspects of its practice. The objectives of this study were to: 1- Detect ethically vulnerable moments of the teleconsultations; 2- Analyse technological safety solutions and the confidentiality adopted by the system; 3- Establish an ethical commitment of all the actors involved in the process. METHODOLOGY. Seventy-six Teleconsultations were evaluated, with emphasis given to the vulnerability of the patient's privacy and confidentiality and in the safety offered by the system of Teleconsulting. RESULTS. Two weak points of the system were detected and will be corrected: A formal absence of “informed consent” and the formal absence of a term of commitment regarding confidentiality, signed by nonmedical actors. However, the system was considered safe in relation to data and network access. CONCLUSIONS. The BH TELEMED project, analysed from an ethical point of view, showed itself adequate and in condition to reach high levels of excellence within ethical standards, confidentiality, privacy, and with safe reproduction of medical data. INDICE/INDEX EXPERIÊNCIA DO INCOR NO DESENVOLVIMENTO, IMPLANTAÇÃO E MANUTENÇÃO DO PACS Gutierrez, M.A. ServiÇO de InformÁTica, Insituto do CoraÇÃO do Hospital das ClÍNicas da Faculdade de Medicina da USP. O Instituto do Coração (InCor) tem envidado esforços para integrar todas as informações clínicas dentro da Instituição. Nos últimos anos o InCor implementou com sucesso um sistema para transmissão, arquivamento, recuperação, processamento e visualização de Imagens Médicas (PACSInCor) e um Sistema de Informações Hospitalares (SI3) que armazena as informações administrativas e clínicas. A integração desses subsistemas forma o Prontuário Eletrônico do Paciente (PEP). O InCor é um dos seis Institutos que compõem o Hospital das Clínicas da Universidade de São Paulo. Como cada um dos Institutos possui o seu próprio sistema de informações, a troca de informações entre os Institutos é também uma questão muito relevante. Este trabalho apresenta a experiência no desenvolvimento de um Prontuário Eletrônico funcional e completo, que inclui controle de acesso, exames laboratoriais, imagens (estáticas, dinâmicas e 3D), laudos, documentos e mesmo sinais vitais de tempo real. Esta apresentação pretende discutir também a modelagem e implantação do PACS-InCor. Para a visualização das imagens, foi implementado um visualizador DICOM, que permite a manipulação de imagens estáticas e dinâmicas, em uma taxa de até 30 quadros por segundo. Uma versão reduzida e simplificada, denominada “miniWebPACS”, foi disponibilizada para a comunidade no endereço http://www.sourceforge.net. Além desse desenvolvimento, também procurou-se integrar os equipamentos médicos que não possuem capacidade para transmitir informações em formato digital. Para tanto, um produto tecnológico foi desenvolvido para integrar dezenas de equipamentos de ultra-som, utilizados na rotina de exames de ecocardiografia, os quais não apresentavam capacidade para transmitir imagens médicas em formato digital para o PEP. O produto desenvolvido permitiu a integração destes equipamentos, reduzindo sobremaneira o investimento necessário para a atualização do parque tecnológico da Instituição. Atualmente, um volume superior a 2,5TB de imagens DICOM já foi armazenado utilizando a arquitetura proposta. Diariamente, o PACSInCor armazena mais de 5GB de dados e tem uma quantidade de acessos superior a 300 usuários. O sistema de armazenamento permite uma visibilidade de seis meses para acesso imediato e mais de dois anos para acesso automático utilizando unidades robotizadas de fitas de alta velocidade (Jukebox). INDICE/INDEX GESTÃO DE FATORES DETERMINANTES DA SUSTENTABILIDADE EM SERVIÇOS DE TELEMEDICINA Gundim, R.S., Chao, L.w. Faculdade Medicina USP - Disciplina Telemedicina INTRODUÇÃO: O uso da Telemedicina para fins assistenciais e educacionais, em um país com as dimensões do Brasil, quando bem planejado, facilita ações de prevenção de doenças e promoção da saúde. O entendimento adequado sobre os fatores envolvidos na sustentabilidade da implantação da telemedicina poderá ajudar a evitar perda de investimentos. A abordagem sob o foco da Gestão e da Logística de Recursos, a fim de detectar os fatores potencializadores e limitadores à implementação de Centros de Telemedicina (CTMs) em unidades básicas de saúde, instituições e hospitais universitários permitirá avaliar os fatores determinantes para o sucesso e continuidade de CTMs dentro do realidade nacional. OBJETIVOS: 1) Desenvolver critérios de mensuração de fatores determinantes de sustentabilidade em relação à implementação e CTMs. 2)Identificar e quantificar os fatores que determinam riscos de insucesso para telemedicina. 3) Sistematizar e Correlacionar os valores dos índices com o desempenho dos CTMs ativos. MÉTODO: Pesquisa de campo em distintas regiões do Brasil, através de fichas de avaliação. A base conceitual para a determinação dos indicadores de sustentabilidade estará baseada no Balanced ScoreCard (BSC) uma metodologia de gestão estratégica em que os objetivos da empresa, são estabelecidos e monitorados pela definição de indicadores de performance, que devem ser estabelecidos a partir de situações sob as perspectivas: econômicas, cliente, processos internos, aprendizado e desenvolvimento. JUSTIFICATIVA E RELEVÂNCIA: Nota-se que o sucesso dos CTMs está claramente associado a uma gestão integrada dos fatores humanos, tecnológicos, financeiros e institucionais. A identificação precoce dos fatores desfavoráveis do ambiente de implementação de CTMs permite desenvolver ações de formação e motivação das pessoas, correção e adequação do ambiente para a melhor incorporação da tecnologia e a desejada continuidade. Dada a importância estratégica da telemedicina e a inexistência de um instrumento que auxilie os gestores na detecção de ambientes maduros para implantação de programas desta natureza encontra-se relevância da execução deste estudo. O resultado poderá servir de apoio à tomada de decisão, pública ou privada, mensurando e indicando quais são as condições mínimas adequadas para a implementação de CTMs, evitando perdas de recursos. INDICE/INDEX GUIAS DE CONDUTA PARA PROGRAMAS DE TELEMEDICINA E TELESSAÚDE DO OBSERVATÓRIO DE TELEMEDICINA DA UNIFESP Sousa, R.M.; Pisa, I.T.; Lopes, P.R.L.; Barsottini, C.G.N.; Gimenez, R.S.S.; Sigulem, D. Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil INTRODUÇÃO. O Setor de Telemedicina da UNIFESP está desenvolvendo um Observatório de Telemedicina destinado a acompanhar a evolução da área no país, bem como das tecnologias que podem ser empregadas para auxiliar na colaboração entre profissionais da saúde. Por se tratar de novos métodos, requer maior atenção aos profissionais que precisam de orientação para a utilização das ferramentas envolvidas. OBJETIVO. Os guias são desenvolvidos para orientar usuários de programas de telemedicina e telessaúde a realizar reuniões síncronas a distância de maneira eficaz e efetiva. MÉTODOS. Para seu desenvolvimento foi necessária uma revisão bibliográfica sobre os diversos temas relacionados, como telemedicina, videoconferência, tecnologias e padrões, aplicações na área de saúde e demais aplicações de suporte. Após essa pesquisa foi estudada a melhor forma de apresentar as informações geradas em relação à sua estrutura e conteúdo. O texto criado foi dividido em pequenas unidades que podem ser agrupadas em diferentes formas, sendo passiveis de localização através de busca por palavras-chave. A forma de armazenamento em banco de dados permite que informações sejam alteradas a qualquer momento, o que facilita sua constante atualização. RESULTADOS. Com oito meses de trabalho, a versão beta 0.2 do guia está disponibilizada na web, em fase de ajustes e revisão. Deverá ter sua versão final até novembro de 2005, quando será gerada uma versão impressa. CONCLUSÕES. A oferta de guias de conduta em telemedicina e telessaúde pode acelerar a aderência dos profissionais da saúde na colaboração médica através do uso de tecnologias de informação e comunicação. INDICE/INDEX HARNESSING THE EHEALTH EXPERIENCE FROM AROUND THE WORLD TO CREATE THE GLOBAL EHEALTHY CITIZEN Richardson, R. J. Imperial College, London, UK INTRODUCTION. The healthcare environment is changing rapidly away from a healthcare delivery model which has been configured to make it easier for the provider and is infrastructure dependent - towards a new healthcare model which will be truly citizen centric and patient friendly. METHODS. eHealth plays a pivotal role in facilitating this transformational change and provides the platform for the delivery models of the future. New applications and interfaces are being developed - such as on hand held devices and PDAs - to make the access of healthcare information and services both ubiquitous and easy to utilise and eHealth and telemedicine allows the specialist skills normally locked inside individual hospitals and clinics - to become widely distributed to the community and across national and international boundaries. There are many examples of eHealth in practice from around the globe and these now need to be evaluated independently and the best and most user friendly examples need to be identified and brought to the attention of decision makers responsible for effecting the healthcare transformation in their own countries. This paper will address these issues with examples of eHealth "best practice" from around the world | INDICE/INDEX HOME OR HOSPITAL IN HEART FAILURE Johnson P.; Mortara A.M*; Ponokowski P. Centre for Ehealth, John Radcliffe Hospital, Oxford, * Foundatzione S Maugeri, Montescano, Italy. ~ Military Hospital, Wroclow, Poland for the HHH Consortium Home telemonitoring of cardiovascular and respiratory parameters have been evaluated in the management of congestive heart failure (CHF). Associated respiratory disorder, chiefly Cheyne Stokes Respiration (CSR) occurs in 50% of CHF patients and seriously affects mortality and morbidity, is the focus of this report. The HHH study is a RCT in Italy, Poland and UK enrolling 450 CHF patients (LVEF <35%, NYHA II-IV) and enrolment NICRAM (blind) with 2 arms (usual clinical practice and home-care strategy) studied over a 12 month period. NICRAM is the 24-hr telemonitoring of respiration, heart rate rhythm and activity using new methods of data transmission and analysis. Prognostic prediction, patient QOL, self-care, and cost-effectiveness in three European countries will be assessed. A clinical assessment, ECG, Echocardiogram, and Quality of Life questionnaire were performed at baseline, 4 and 12-months and composite measure of patient well-being (death, hospital bed days, symptom score and quality of life). INDICE/INDEX HOMEM VIRTUAL DA HANSENÍASE UMA ESTRATÉGIA PARA AUMENTAR A PROCURA POR DIAGNÓSTICO E TRATAMENTO Trindade M.A.B.1, Wen C.L.1, Festa C.N.1, Andrade V.G.2, Soares R.C.F.R.3 1 Faculdade de Medicina da Universidade de São Paulo, 2Organização Panamericana de Saúde, 3Ministério da Saúde do Brasil INTRODUÇÃO: A hanseníase doença infecciosa crônica é um problema de saúde pública brasileiro. O Brasil está após a Índia em número de casos registrados e é o quinto país na taxa de detecção de casos novos. A divulgação dos principais sinais e sintomas, manchas dormentes e do tratamento gratuito visa estimular a população a procura por diagnóstico e tratamento colaborando para quebrar a cadeia de transmissão e prevenir incapacidades. Com este intuito elaboramos o vídeo a ser apresentado utilizando novas tecnologias aplicadas na Telemedicina MATERIAL E MÉTODOS: Para elaboração do vídeo foi utilizado material iconográfico do Projeto Homem Virtua da Telemedicina sob a orientação da Dermatologia da FMUSP, com assessoria e financiamento da OPAS/OMS e distribuição pelo Ministério da Saúde como patrimônio da população brasileira, em especial para Unidades Básicas de Saúde , Unidades Escolares do Ensino Fundamenta RESUMO: Esta apresentação pretende divulgar material desenvolvido com novas tecnologias para realçar os sinais e sintomas iniciais da hanseníase mancha e/ou área anestésica que, se não tratada na fase inicial, poderá ser transmissível e causar incapacidades físicas. É informado que o tratamento é gratuito, possibilita a cura da doença, e é realizado na UBS de mais fácil acesso. CONCLUSÃO: O vídeo Homem Virtual da Hanseníase concebido com material iconográfico pretende ser uma estratégia para aumentar a procura da população geral por diagnóstico e tratamento. email: [email protected] INDICE/INDEX INDIAN INITIATIVES AND EXPERIENCES IN TELEMEDICINE FOR SPECIALITY HEALTHCARE DELIVERY TO THE RURAL AND REMOTE POPULATION - A DEVELOPING COUNTRY MODEL Satyamurthy LS, Murthy RLN & Bhaskaranarayana. A Indian Space Research Organisation (ISRO), Bangalore, Karnataka, India India is the 7th largest country in the world with an area of 3.2 million square kilometers and one Billion plus population. While a vast majority of India's population lives in the rural areas, 75% of the qualified doctors practice in urban areas. Noting this important dichotomy, especially the Urban/Rural Health Divide, the Indian initiatives in Telemedicine/Telehealth was started in the year 2001 and primarily spearheaded by the Indian Space Agency ISRO.The focus of this endeavour has been on providing technology and connectivity for Healthcare Delivery in terms of the services for Tele-consultation and treatment between Remote/Rural District Hospital and Super Speciality Hospital, Continuing Medical Education (CME) including training of Doctors and Paramedics, Mobile Telemedicine for Rural Health camps especially for Ophthalmology and Community Health and ICT related to Primary Healthcare. For implementing this daunting task, an integrated approach of technology development, standards and cost effective systems were evolved in association with the various Government/NGO Agencies, Speciality Hospitals and the Industry, including introduction of innovative insurance schemes for the rural population.Presently ISRO's Telemedicine Network consists of 135 Hospitals 105 Remote/Rural/District Hospitals/Health Centres connected to 30 Super Speciality Hospitals located in major cities.ore than 50000 patients have been provided with Tele-consultation and treatment. A private impact study conducted on one thousand patients treated through Telemedicine network revealed that there was a cost saving of 81%. This experience is set to enter operational arena for a sustainable business model to facilitate public/private partnership involving insurance industry for long-term sustainability. The paper discusses the initiatives, the major thrust areas, technology and utilisation aspects, the road map and the vision for future development of an operational Telemedicine network in the country. INDICE/INDEX INTERACTIVE CASE DISCUSSION: AN OTOLARYNGOLOGY ELEARNING PROGRAM BASED ON PROBLEMS Campelo, VES; Wen, CL; Pinheiro Neto, CD; Figueiredo, L; Bento, RF Faculty of Medicine, University of São Paulo We have developed an integrated e-learning model using interactive software. The model is divided into two parts: (1) A software distributed on Cds, and (2) An internet website. The Cd is based on case reports and the user need to evaluate the case step-by-step. The progress in the program depends on the answer of some questions about the case. All the questions have explanations. After case resolution, the user may assess literature review and specialists comments about the topics. In the internet interface, the user needs to complete an interactive test. Threedimensional (3-D) animated models are used to improve learning, principally about anatomy and pathophysiology. The first CD is about sudden hearing loss and others subjects will be assessed quarterly. The interactive case discussion seems to be a good alternative as a e-learning program and is focused on individual learning. INDICE/INDEX INTEGRATING TELE-NURSING AND TELE-HEALTH WITH HEALTH INFORMATICS: NEED FOR STANDARDIZATION TO ACHIEVE SEMANTIC INTEROPERABILITY AND IMPROVE PATIENT SAFETY. Professor Hovenga, J.S. RN, PhD, FCHSE, FRCNA, FACHI, MACS Program Director, Health Informatics, Head, School of Information Systems Faculty of Informatics and Communication - Central Queensland University, Australia. Making the best possible use of available technologies to safely deliver quality health services requires every nation to establish a framework that will enable health professionals and health information systems to communicate with each other in a timely and reliable manner. Such a framework consists primarily of the adoption of any number of agreed standards but also on agreed policies and methods of operation. This creates a new national health information environment facilitating all appropriate stakeholders (users) to find, request, retrieve and provide relevant patient records, data, information and knowledge rapidly and accurately subject to patient authorization where relevant. Such an approach takes advantage of significant investments made in the acquisition of telecommunication and information technologies nationally and by many health care providers within the country. Nurses represent the largest group of organised health professionals in most countries. Nurses play a critical role in creating an effective health care information infrastructure via clinical nursing documentation and health information systems. In many instances nurses make recommendations regarding the purchase of systems or have responsibility for their implementation. Nurses need to be educated such that there is a sizable national capacity of nurses able to significantly contribute to the establishment and adoption of the desired national framework as well as the necessary standards, policies and methods of operation. This presentation intends to explore opportunities and barriers for nurses to contribute to the creation of an effective national health information framework that will enable the integration of tele-nursing and tele-health with health and nursing informatics for the purpose of improving patient safety and the quality of nursing service delivery in any health care setting. It will conclude with some ideas on how to make the most of these opportunities and to overcome the barriers. [email protected] http://infocom.cqu.edu.au/Staff/Evelyn_Hovenga/ [email protected], http://infocom.cqu.edu.au/Staff/Evelyn_Hovenga/ INDICE/INDEX ISfTeH AND THE ROLE OF INTERNATIONAL ORGANISATIONS AND INSTITUTIONS Lievens, F. 1, 2 Jordanova, M. 2,3 1 ISfTeH, Zurich, Switzerland; 2Med-e-Tel, Luxembourg, G. D. of Luxembourg 3 Institute of Psychology, Bulgarian Academy of Science, Sofia, Bulgaria The aim of this presentation is to briefly present ISfTeH close and fruitful collaboration with various international organisations and institutions such as WHO, UNOOSA, ITU, EC, etc. Tremendous efforts were made by the ISfTeH Board to establish and develop these partnerships, contributing as such to fulfil its mission of promoting and supporting Telemedicine/eHealth activities worldwide and to be recognized as an umbrella for national Telemedicine and eHealth organisations. ISfTeH is truly the United Nations in Telemedicine/eHealth. On the other hand, close contacts with international bodies are a must for ISfTeH to comply with its engagements towards its members and act as: - Moderator in all aspects of healthcare: delivery, science, education, business, etc, - Feeder for projects and information, - Assistant in the set up of new national Telemedicine/eHealth associations. INDICE/INDEX LAUNCH OF @HEALTH: A VIRTUAL COMMUNITY FOR APPLICATIONS OF E-HEALTH TECHNOLOGIES IN EUROPE AND LATIN AMERICA VÉLez BeltrÁN, J.A.; Navarro Newball, A.A.; Salvatore, P.; Salas, L.C. Colombian Telemedicine Centre - Cali, Colombia CIAOTECH Srl - Roma, Italia KEYWORDS. Community, Telehealth, Telemedicine, Information Society. OBJECTIVE. The overall objective of the envisaged specific support action “@HEALTH" is to enable European and Latin American researchers, policy makers and other relevant players operating in the field of e-health to access and exchange knowledge, skills, technologies and facilities through the development of an e-health virtual community. METHODS. The project´s methodology includes the following phases: Phase I: Mapping competences, players, and resources in Europe and Latin America related to e-health applications and technology. Phase II: Setting up the virtual community web portal. Phase III: Awareness creation action. Phase IV: Dissemination and exploitation: web actions, e-newsletters, press releases, and participation in international conferences and seminars. RESULTS. As a specific support action the project will not directly lead to scientific results, but it will stimulate the achievement of specific scientific objectives in emerging e-health applications and enabling technologies oriented to: professional networking; integration of the clinical care process management; provision of web-based health information and healthcare, including remote monitoring and patient care. At the moment, @HEALTH is built upon a consortium including European and Latin American research organisations representing the top level competences in the e-health sector, and a team of experts having successfully carried out direct experiences in the development of international research and technology transfer networks. already exist at the practice, program, and policy levels. Can global ehealth contribute to the process? The simplistic response is absolutely. Global e-health has the potential to address causes of inequality directly, and thereby address inequity indirectly. For example, small area variation across subgroups of practitioners may be identified as a factor contributing to inequality. A variety of e-learning options exist (training, mentorship, continuing education) that, if determined to be appropriate, can be implemented through specific voluntary or mandatory educational (practice), training (program), or standardisation (policy) interventions. But issues also arise. For example, e-health has the potential to exacerbate as well as ameliorate inequality to broaden the 'digital divide' (and other divides). Poorer people are generally most in need of healthcare support, yet they are the group least likely to have access to rapidly advancing technological solutions. Our challenge is to identify, develop, and apply culturally appropriate, broadly available e-health solutions, and to concurrently develop the population and professional skills necessary to use them. In this regard, global e-health alone will not suffice. To impact other determinants that affect individual and population health, such as literacy and employment skills, it will be necessary to develop initiatives that work in concert, developing e-learning and e-business opportunities concurrently with e-health applications. To achieve this, a systematic approach is required. One that includes: identification of the magnitude of health gradients, needs and readiness assessment, determination of whether e-health is a viable option, and finally implementing and assessing the impact of any global e-health solution. Such a process would be equally applicable and valuable to developing countries as to developed countries, but the context and solutions would be different. Applying this approach will allow appropriate e-health solutions to be applied in reducing inequality and inequity wherever it is found, and thereby help level the playing field for the health of the world's population. INDICE/INDEX MODELO DE EDUCAÇÃO À DISTÂNCIA EM HANSENÍASE VOLTADO PARA REDE DE DETECÇÃO DE CASOS E DIAGNÓSTICO. Paixão M.P., Miot H.A., Chao L.W. Disciplina de Telemedicina da Faculdade de Medicina da USP. O Brasil é atualmente o segundo país em maior número de casos de hanseníase no mundo. A maior concentração dos casos ocorre na região da Amazônia legal, onde fatores como extensão geográfica e dificuldades de acesso dificultam o atendimento de saúde às populações isoladas, que é agravado pela heterogeneidade de distribuição de médicos e de dermatologistas. O uso de telemedicina pode auxiliar no reconhecimento de casos de hanseníase e permite criar uma rede de teletriagem através da implementação programas de prevenção e educação continuada à distância. Este projeto de pesquisa tem por objetivo desenvolver ambiente de educação à distância para treinamento em identificação clínica de hanseníase, e avaliar o impacto dele como recurso para formação de uma rede de triagem à distância através de ambulatório virtual, com: (a) criação de curso de treinamento para não-médicos, voltado para o reconhecimento de sinais suspeitos de hanseníase; (b) criação de cursos de capacitação e de atualização à distância em hanseníase para médicos generalistas e envolvidos com o Programa de Saúde da Família (PSF); (c) estruturação de ambiente de segunda opinião (online e offline) em hanseníase; (d) avaliação do potencial impacto da teleducação na formação de profissionais não-especialistas. Os participantes envolvidos no projeto serão médicos generalistas e indivíduos não-médicos que tenham contato com grande número de indivíduos. Serão oferecidos para os sujeitos da pesquisa cursos de capacitação e de atualização para médicos, e curso de treinamento para não-médicos. Serão feitas avaliações pré-treinamento e após este, através de formulário padronizado, de forma a permitir avaliar o impacto do uso dessa técnica. Todo o processo será feito remotamente dentro do ambiente virtual do Cybertutor (tutor eletrônico), onde serão inseridas as informações e implementados recursos educacionais. Na última fase esse projeto possibilitará a integração com a assistência remota à paciente, possibilitando a emissão de segunda opinião nos casos com dificuldades diagnósticas ou terapêuticas. Representará, portanto, importante recurso auxiliar na assistência à distância. INDICE/INDEX NEXT GENERATION BROADBAND AND WIRELESS NETWORKS TO SUPPORT ADVANCED TELEMEDICINE APPLICATIONS Szabo, C.A. Budapest University of Technology and Economics, Budapest, Hungary Development of telecommunications networks has been and partially is technology-driven. This was particularly true for the years of telecom boom in late 90s. Telecom operators and also, to some extent, public entities such as municipalities laid down a large amount of optical cables and equipment. As a result, multiple terabits of bandwidth was deployed in the core part of the networks, which is to a large extent unused even today. On the other hand, telcos did not pay too much attention to providing high speed access to customers, especially to residents and non-profit organizations such as health care institutions, except the widespread deployment of ADSL which is the only “broadband” technology deployed worldwide. (However it only provides data rate of about one Mbps and besides does it in an asymmetric way, offering much less in the uplink direction.) After the recent downturn of the telecom industry, operators started to be much more customer and service oriented. The new direction of “Next Generation Networks” is no longer just a technology development: moving to IP-based communications serves the needs of applications and services in many ways. In the wireless/radio area, the term “Beyond 3G” means no longer a specific new technology, on the contrary, it means a combined use of a variety of existing and emerging wireless access technologies, to achieve the objective of being “always best connected”, together with IP as the universal platform here, too. What can all this bring to the telemedicine world? Actually, a lot and not only increased bandwidth. Telemedicine applications do indeed need bandwidth, as for example transmission of uncompressed radiology images with a reasonable delay need 10 Mbps or more and this bandwidth has to be delivered to the end user no matter whether it is an office in a hospital or the medical specialist's home. Telemedicine applications can benefit from the recent developments and emerging telecommunication technologies in many additional ways. Rural and underserved areas can be covered, the growing populations of seniors can be monitored at their homes, the quantity of medical errors can be reduced and, in general, the effectiveness of health care services can be increased. Third generation cellular networks provide considerable data rates which makes it possible to access to and exchange medical data in a global environment. New high speed wireless technologies offer tens of Mbps within the medical enterprise or within a metropolitan area. The new wireless MAN technology can be deployed not only by service providers but also by communities or groups of non-profit organizations such as hospitals, due to the liberalization of the corresponding frequency bands. New personal area communication technologies such as Bluetooth plus information collecting and monitoring devices (intelligent cameras and RFIDs, as examples) offer the right technology background for home health care applications. The paper gives an overview of the state-of-the art and emerging communication solutions that are of primary importance for telemedicine applications, for non-communications specialists. The overview will focus on next generation broadband and wireless networking technologies and solutions that could support advanced existing and emerging telemedicine applications. First, the requiremements of telemedicine applications are outlined, including bandwidth, response time, loss, pervasiveness, mobility, security and privacy, payment, user devices, management. Then an overview of relevant optical and wireless broadband technologies will be given, focusing mainly on wireless solutions for providing telemedicine services in metropolitan, local and personal enviroments. Regarding wireless, the combined and flexible use of different wireless technologies (WLAN, WiMAX, Bluetooth, 2.5G/3G cellular) will be emphasized, with vertical handover among them as the application scenarios require. The technology discussion will be accompanied with case studies of systems deployed or planned in Europe. [email protected] INDICE/INDEX OBJETOS EDUCACIONAIS: APLICAÇÃO NO ENSINO DE FUNDAMENTOS DE ENFERMAGEM COGO ALP; SILVA APSS; ALVES RHK. Laboratório de Ensino Virtual Enfermagem, Escola de Enfermagem Universidade Federal do Rio Grande do Sul Porto Alegre RS Brasil Introdução: Entende-se por objetos educacionais ou de aprendizagem os recursos de multimídia que possibilitem interatividade para apoiar as práticas de ensino-aprendizagem através das tecnologias da informação e da comunicação. Possui como características a reusabilidade, adaptabilidade, acessibilidade, ser autoexplicável e estar disponível em repositório de objetos. O desenvolvimento de objetos educacionais sobre temas de fundamentos de enfermagem tem sido uma das atividades realizadas pelo Laboratório de Ensino Virtual Enfermagem, e a descrição deste projeto é o objetivo deste trabalho. Métodos: As fases de desenvolvimento envolvem desenho da estrutura do recurso educativo, desenvolvimento dos objetos educacionais empregando softwares Macromedia Flash MX®, Adobe Photoshop® e CorelDRAW®, implementação e avaliação do material produzido. Resultados: Os materiais desenvolvidos referem-se às temáticas: administração de medicamentos, balanço hídrico, curativos, oxigenoterapia, punção venosa, sinais vitais, sondagens nasogástrica, nasoentérica, vesicais. Estes objetos são constituídos de hipertexto, botões explicativos sobre os conceitos centrais, imagens digitais demonstrando os procedimentos “passo-a-passo”, links para conteúdos complementares e ao final de cada objeto, é disponibilizado exercícios de revisão de conteúdo. Também encontram-se em fase de desenvolvimento animações (jogos educativos) sobre montagem de material para realização de procedimentos; passagem de cateter de oxigênio e de sondas (SNG e SNE); punção venosa periférica. Conclusões: Pretende-se avaliar os objetos apresentados junto aos acadêmicos de enfermagem, quanto a interação e os níveis de compreensão que os mesmos propiciam; e a adequação dos conteúdos junto a especialistas. Os objetos educacionais desenvolvidos poderão ser compartilhados com a comunidade de enfermagem a partir de sua disponibilização em repositório. Apresentação em Pôster Contato: Ana Luísa Petersen Cogo Rua Sacadura Cabral,130/202 Porto Alegre-RS-Brasil CEP 90690-420 Fone: 51- 33165353 Email- [email protected] INDICE/INDEX OVERVIEW OF E-HEALTH PROJECTS IN SOUTH AFRICA Fortuin, J.B.; Molefi, M. Telemedicine Lead Programme, Medical Research Council, South Africa BACKGROUND. Many challenges affect South African health care delivery and too highlight a few they include: (i) lack of accessibility to primary health care facilities and specialist hospitals, and (ii) the cost associated with accessing specialist and specialist hospitals. E-Health has proven to be successful in many developed countries this still has to be proven in developing countries. AIM. To identify E- Health projects in South Africa in which the Telemedicine Lead Programme, Medical Research Council is directly involved and use information gathered to make recommendations in terms of E-Health applications in developing countries. METHODS. We identified all implemented and operational E-Health projects. The following breakdown of each project was requested: (i) aim and objectives, (ii) target group, (iii) results \outcomes. RESULTS. Four projects were identified, the projects included: 1. Mindset Health Channel 2. Teledermatology 3. Teleradiology Project 4. Primary Health Care Testbed Project CONCLUSION. South Africa has successfully implemented E-Health projects over the past few years with very little infrastructure. Many lessons have been learnt during this time. The success of the projects includes the use of simple technology to deliver health care to under resourced areas at a distance. The challenges include cost, support and maintenance at sites, capacity development and sustainability. To address the above issues there needs to be collaboration with industrialised countries and research initiatives (i.e. evaluation of E-Health) needs to be implemented. INDICE/INDEX PARAMETRIZAÇÃO DO USO DE INDICADORES NA GESTÃO DO CONHECIMENTO EM SAÚDE PÚBLICA ATRAVÉS DA PRÁTICA DE E-LEARNING Tachinardi, U. A. S.; Borges, C. L.; Almeida, A. L.; Guerra, I. M.; Pires, F. S. Secretaria de Estado da Saúde de São Paulo São Paulo / SP - Brasil INTRODUÇÃO. Este trabalho tem como objetivo a parametrização do uso de indicadores na gestão do conhecimento em Saúde Pública através da prática de compartilhamento de conhecimento remoto em educação continuada. A análise de valores a serem computados será viabilizada pela implementação de projeto de E-learning pela Secretaria de Estado da Saúde de São Paulo, em convite à colaboração acadêmica/operacional direcionado a instituições reconhecidamente atuantes em projetos de infra-estrutura tecnológica neste setor: Universidade de São Paulo (USP) Faculdade de Medicina/Disciplina de Telemedicina e Escola Politécnica/Laboratório de Arquitetura e Redes de Computadores, Universidade Federal de São Paulo (UNIFESP) - Departamento de Informática em Saúde, Universidade Estadual Paulista (UNESP), Biblioteca Virtual em Saúde (Bireme) e Fundação Vanzoline. METODOLOGIA. O estudo metodológico se identifica na análise relacional de valores a serem utilizados como indicadores na gestão do conhecimento e as diferentes formas de aproveitamento dos recursos obtidos pelos procedimentos envolvidos com a aprendizagem remota. Serão avaliados em sua capacidade de geração e utilização de indicadores relacionais os procedimentos de estabelecimento de padrões de comunicação, sistemas e conexões, controle de avaliação, capacitação à distância, emissão de certificação digital, administração de conteúdo, acervo bibliográfico, integração e extração de dados, controle e auditoria de processos, divulgação do conhecimento, comunicação on-line e desenvolvimento de linhas de pesquisa. RESULTADOS E CONCLUSÃO. Os resultados esperados pela parametrização, viabilizada pós-implantação do Projeto E-learning SES/SP, levam à construção de um modelo de utilização de indicadores na gestão do conhecimento em Saúde Pública, auxiliando o Estado na gestão administrava da informação. INDICE/INDEX PARTNERSHIP BETWEEN MEDICAL MISSIONS FOR CHILDREN WORLDWIDE NETWORK AND THE STATE UNIVERSITY OF RIO DE JANEIRO, MEDICAL SCHOOL/ FCM-UERJ. Eisenstein, E.1; Monteiro, AMV1; Gismondi, RC1; Mário Jr, MJ1, Brady, P ; Brady, F. The State University of Rio de Janeiro, Medical School. FCM-UERJ1, Medical Missions for Children2 Purpose: Medical Missions for Children (MMC) is an American NGO, dedicated to serving the medical needs and care of catastrophically ill children in underserved U.S. and international communities. Methods: MMC provides medical content through its Global Telemedicine and Teaching Network™ (GTTN) a real-time, interactive, satellite broadcast technology and Internet-based communications platform. Presently, MMC's network encompasses 36 pediatric healthcare facilities in Latin America, Africa, India, and Eastern Europe and facilitates the treatment of 1,500 children each month and since 1999, has helped nearly 23,500 children, all over the world. The Medical School of the State of Rio the Janeiro is the country representative for Medical Missions in Brazil Results: Continuous education through videoconferencing has been done using satellite broadcast technologies and Internet 2. Therefore ongoing MMC-GTTN has provided access to cutting-edge research, new treatment protocols, and diagnostic techniques by a network of pediatric specialists in mentor and reference hospitals. Conclusion: For more information, connect http://www.mmissions.org. or http://www.lampada.uerj.br/telemedicine. Congresso | Instruções para apresentação de trabalhos Apresentação de trabalhos oral, vídeo ou pôster Data limite de envio: 10 de agosto de 2005. Idiomas Oficiais: Inglês e ou Português*. O título do trabalho deverá ser em letras maiúsculas Na linha seguinte o(s) nome(s) do(s) autore(s), sobrenome e iniciais dos nomes. Sublinhar o nome do apresentador. Na linha seguinte indicar a instituição ou empresa, cidade, estado e país. Antes do corpo do trabalho deixar uma linha em branco e, depois, mencionar introdução, métodos, resultados e conclusões. Fonte: times new roman, 12, espaço simples. Número de palavras do corpo do trabalho: até 250. Formato Word. Enviar para o e-mail: [email protected] Não serão aceitos trabalhos por fax. Anotar sua preferência de apresentação ( ) Oral ( ) Vídeo ( ) Pôster * Trabalhos enviados em português não serão publicados nos Anais do X Congresso da ISFT mas nos Anais do II Congresso do CBTms. Atenção: 1) Só serão aceitos trabalhos de autores (pelo menos 1) inscritos no congresso; 2) A comissão cientifica poderá selecionar seu trabalho para apresentação em categoria diferente da de sua escolha. 3) Para receber a confirmação de aceitação do seu trabalho, informar nome, endereço e e-mail. INDICE/INDEX REDE CATARINENSE DE TELEMEDICINA - RESULTADOS, TECNOLOGIA E PERSPECTIVAS Wangenheim, A e Nobre, LF Projeto Cyclops UFSC e Coordenação de Telemedicina - Secretaria de Estado da Saúde de Santa Catarina O Governo do Estado de Santa Catarina e o Projeto Cyclops da UFSC estão implantando em Santa Catarina a Rede Catarinense de Telemedicina RCTM. A RCTM é uma iniciativa pioneira de oferta de serviços de Telemedicina em larga escala integrada à rotina clínica para usuários do Sistema Único de Saúde - SUS. Para tanto está sendo implantada a disponibilização e interiorização de equipamentos de eletrocardiografia e radiologia em todo o Estado, conectados através de uma rede específica a centros de diagnóstico regionais em hospitais específicos do Estado, além de um Centro de Telediagnóstico em construção em Florianópolis. Os equipamentos conectados à RCTM localizam-se desde em Postos de Saúde e pequenos hospitais do Interior até grandes Hospitais Regionais do Interior que fornecem exames para uma região e possuem déficit de pessoal qualificado para realização de laudos. Os exames estão sendo realizados por técnicos qualificados disponíveis localmente e o serviço de laudo é fornecido por médicos qualificados que realizam os laudos à distância utilizando workstations especialmente desenvolvidas a providas de recursos de análise de imagens e sinais, desta forma reduzindo-se drasticamente o trânsito de pacientes, aumentando-se a oferta por otimização das capacidades e reduzindo-se tanto custos operacionais diretos como custos materiais e humanos provenientes da demora no atendimento e no fornecimento de resultados de exames. A RCTM se baseia em uma tecnologia DICOM e um portal Web específicos desenvolvidos pela a UFSC especialmente para este fim. Na palestra a ser apresentada vamos descrever a tecnologia desenvolvida, detalhar a filosofia operacional e apresentar os resultados obtidos até o momento. INDICE/INDEX SALA DE LAUDOS VIRTUAL Nobre, L.F. Cyclops, Universidade Federal de Santa Catarina. "Sala de Laudos Virtual" é uma ferramenta integrada ao sistema "CMS Cyclops Medical Station", voltado para a área da teleradiologia, desenvolvida pelo Projeto Cyclops da UFSC, que oferece aos médicos recursos de estação radiológica DICOM e provimento de laudos em formato DICOM Structured Report. Seu principal objetivo é acessar informações de exames de imagem no padrão DICOM 3.0, compartilhar estas imagens, e criar um canal de comunicação através das tecnologias de voz sobre IP e compartilhamento de interface de edição e análise de imagens radiológicas através de um protocolo de serviços especialmente desenvolvido. Esta solução permite a criação de um ambiente colaborativo entre médicos localizados à distância, utilizando a Internet para a discussão de casos e elaboração conjunta de laudos e diagnósticos. O ambiente da Sala de Laudos Virtual oferece aos médicos visualização de imagens, aplicação de algoritmos de processamento de imagens, além de edição e realização de anotações em conjunto sobre as imagens compartilhadas. Com esta tecnologia, é possível a utilização de conexões de rede IP de largura de banda limitada para o compartilhamento e discussão de exames radiológicos com alta qualidade de imagem, sem a perda de parâmetros diagnósticos em relação àquelas obtidas através do uso de equipamentos de videoconferência tradicionais. INDICE/INDEX SATELLITE BASED TELEMEDICINE APPLICATION IN AMAZON AREA Sachpazidis, I. Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt, Germany INTRODUCTION. Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundred of kilometers to receive a medical diagnosis. In this paper we will propose a medical network based on stateof-the-art medical applications that address the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. In the current paper we are going to describe a medical network deployed in Amazon area of Para state in Brazil. MATERIALS AND METHODS. Proving medical services to remote areas in Amazon, satellite communication is vital. AmerHis [1] is an advanced communication payload, based around the Alcatel 9343 DVB On-Board Processor, carried by the AMAZONAS satellite of Hispasat. This processor has the capacity to provide the demodulation, decoding, switching, encoding and modulation for the four transponders on Amazon region. Each Ku-band transponder covers one of the four geographical regions served by the satellite, namely: Europe, Brazil, North and South America. AmerHis offers broadband interconnectivity to users anywhere within the four geographical areas covered by Amazonas. Furthermore, besides the communication over satellite a medical application need to be deployed. This application called TeleConsul, developed by Fraunhofer IGD and MedCom GmbH, in Germany. TeleConsult [2] platform provides physicians with a wide spread of functionalities. For example, the doctors working with it are able to make notes on the digital medical image and send it to the expert doctor. This could happen either in offline-mode (messages will be sent at a favorable date and time, for example during the night) or in online-mode (real-time tele-consultation). Presently, there are two Excellence Hospital Centres in Brazil that compose the T@lemed Project [3]: Santa Casa Hospital, in Porto Alegre, Rio Grande do Sul, and FAHUCAM, in Vitória, Espírito Santo. The current network is extended to Amazon areas in Para states. The state of Pará presents the rate of general mortality of 3,65 deaths in 1.000 inhabitants. The main reasons are the following: blood circulation diseases birth associated diseases breath associated diseases infectious diseases external causes The children mortality is about 20 to 49 cases in 1.000 inhabitants. Some common diseases: diarrhea, malaria, tuberculosis, typhoid, hepatitis, leptospirosis, yellow fever, tetanus. It's estimated that 35% to 40% of the total medical cost of the cities are expended in treatments in other urban centers. Besides that, there is a great difficulty in the human resources availability in remote areas where a large part of the population lives in poverty. The high complexity medical services are totally concentrated in Belém area. REFERENCES. [1] http://www.esa.int/esaTE/SEMJPRL26WD_index_0 [2] Kontaxakis, G., Walter, S. and Sakas, G. (2000) “EU-TeleInViVo: an integrated portable telemedicine workstation featuring acquisition, processing and transmission over low-bandwidth lines of 3D ultrasound volume images”, Information Technology Applications in Biomedicine: Proceedings of IEEE EMBS International Conference, p. 158 163. [3] http://www.alis-telemed.net E-mail: [email protected] INDICE/INDEX SISTEMA DE APOIO À DECISÃO PARA AVALIAÇÃO POSTURAL Mancini, F.1; Pisa, I.T.1; Lopes, P.R.L. 1; Barsottini, C.G.N. 1; Roque, A.C.2 1 Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2 Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (FFCLRP) Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil INTRODUÇÃO. A avaliação postural é uma ferramenta fundamental no diagnóstico do alinhamento dos segmentos corporais de um indivíduo. Porém, uma deficiência dessa área é não haver uma descrição detalhada do alinhamento postural da população brasileira ou parte dela. OBJETIVO. Este trabalho tem por objetivo apoiar diretamente o diagnóstico do alinhamento dos segmentos corporais de um indivíduo, a partir da classificação de padrões sobre avaliação postural, e utilizando-se desta classificação, desenvolver um sistema de apoio à decisão médica. METODOLOGIA. Um projeto de pesquisa, patrocinado pelo CNPQ, intitulado Software Gratuito Para Avaliação Postural com Tutoriais Científicos e Banco de Dados, tem como um dos objetivos criar um repositório de dados sobre avaliação postural, armazenando uma coorte da população brasileira. Utilizando-se deste repositório, ferramentas de análise estatística semi-paramétrica de dados, como redes neurais artificiais, realizam mapeamentos não-lineares de dados, podendo reconhecer padrões entre um conjunto de variáveis de entrada. Ou seja, redes neurais artificiais podem agrupar em classes padrões referentes ao alinhamento postural da população brasileira, com base no mapeamento de dados armazenados no repositório de dados sobre avaliação postural. RESULTADOS. Este trabalho resulta em um sistema de apoio à decisão médica, a partir do algoritmo gerado pela classificação de padrões sobre avaliação postural de cidadãos brasileiros, acoplado ao Software Gratuito Para Avaliação Postural. CONCLUSÃO. O desenvolvimento deste trabalho apoiará ao diagnóstico do alinhamento dos segmentos corporais de um indivíduo, pois a utilização deste sistema de apoio à decisão colabora diretamente com a prática clínica. INDICE/INDEX SISTEMA DE TELEDUCAÇÃO À DISTÂNCIA VOLTADO A EDUCADORES FÍSICOS Corrêa, F.G.C.; Chao, L.W. Faculdade de Medicina da USP. São Paulo, SP. Brasil Em resumo este trabalho apresenta um projeto que relata um sistema de educação à distância destinado a educadores físicos, objetivando promover a continuidade do seu processo formativo, e tendo como conteúdo, conceitos e aplicações de metabologia, nutrição, fisiologia do exercício e treinamento em atividade física, possuindo como ferramentas de ensino o tutor eletrônico de ensino à distância conhecido como cybertutor, iconografias em três dimensões de partes da anatomia do corpo humano relevante a este processo de aprendizagem (homem virtual) e vídeos de apoio ao conteúdo proposto no cybetutor. Todas as ferramentas utilizadas neste projeto focam a prática da atividade física com qualidade e todo o universo que a norteia, e o conteúdo inserido no cybertutor é a “chave mestra” para o desenvolvimento harmonioso deste processo, pois trata de conceitos e aplicações de conteúdos que são diariamente aplicados no desenvolvimento de sua profissão e é a base para o desenvolvimento das demais ferramentas, já o homem virtual é uma tecnologia inovadora que proporciona melhor entendimento do conteúdo através dos recursos da terceira dimensão (3D) e os vídeos de apoio que são inserções áudio-visuais colocadas no decorrer das aulas, através de ícones de acesso nas páginas do cybertutor, e que tem como objetivo principal à fixação do conteúdo proposto no tutor eletrônico através de informações novas ou complementos dessas informações. Para utilização deste projeto o usuário receberá login e senha para acesso ao cybertutor e um kit de material no qual estarão os discos com os vídeos o homem virtual, e todo manual explicativo. INDICE/INDEX SIX YEARS OF TELEMEDICINE AT HOSPITAL SÍRIO-LIBANÊS: EXPERIENCE REPORT. Gundim, R.S. Instituto de Ensino e Pesquisa Hospital Sírio-Libanês (IEP/HSL) São Paulo Brasil INTRODUCTION. The Service of Telemedicine was implemented in October 1999 as an initiative of both the Oncology Center and the Directory of Hospital Sírio-Libanês, and it was designed to fulfill two objectives: Assistance ( International Second-Opinion ) and Educational/Scientific (Lectures, Case Studies and Distance Education). OBJECTIVE. The purpose is to report the experience of the Telemedicine Service at IEP/HSL from 1999 to 2005. METHOD. This is a retrospective study to examine the most relevant aspects such as technologies, statistics and the outstanding points of the activities. RESULTS. Telemedicine at IEP/HSL started with a videoconferencing system and several pertinent peripherals. In 1999, with the mentioned structure, the International Second-Opinion Program was implemented in collaboration with the MSKCC (1) 42 cases, parallel to the scientific meetings 52 ones. In 2001, 41 videoconferences were held to exchange experiences, broadcast lectures and develop long distance congresses. At the same year it was the unique content source of medical update at the recently founded IP-TV via satellite 157 transmitions. Currently it develops a collaborative network to train people from the North and Northern areas of Brazil, and search for partnership with other Telemedicine Centers as of FMUSP (2), UFSC (3), UNIVAP (4), among others. The presented statistics refer to the six years period. CONCLUSION. This experience shows that financial, technological, scientific and institutional sustainability should be based on the investments in technology, communication and cooperation among institutions. A collaborative action enhances the structuring of telemedicine programs, contributes to the dissemination of best practices and to the quality of health assistance. Acronyms: 1 - MSKCC Memorial Sloan-Kettering Cancer Center of New York 2 - FMUSP Faculty of Medicine of The University of São Paulo 3 - Federal University of Santa Catarina 4 - Vale do Paraíba University INDICE/INDEX TELEASSISTÊNCIA E TELEEDUCAÇÃO EM HANSENÍASE: COMO UMA ESTRATÉGIA DE PROGRAMA EM SAÚDE 1,4 1 1 2 Trindade M.A.B. , Festa C.N. , Wen C.L. Andrade V.G. , Soares R.C.F.R.3, Carvalho M.L.M.4, Ferreira S.R.G.5, Almeida M.E.B.T.M.P.6 Médicos das Unidades Básicas de Saúde5: Manso VLS, Yamashitafuji TMT, Souza LR, Trindade RA, Silva AA, Macedo RLC, Fukada M, Ribeiro LA Faculdade de Medicina da Universidade de São Paulo1, Organização Panamericana de Saúde2, Ministério da Saúde3, Secretaria Estadual da Saúde de São Paulo4, Secretaria Municipal da Saúde de São Paulo5, Pontífice Universidade Católica-SP6. INTRODUÇÃO: Para aumentar as oportunidades de diagnóstico e tratamento, está sendo realizado um projeto piloto para Validação do Diagnostico Virtual da Hanseníase na FMUSP-SP com a participação da OPAS/OMS, Ministério da Saúde e Secretaria da Saúde do Município e do Estado de São Paulo, os quais estão catalisando esta iniciativa de utilizar ferramentas da Telemedicina e Teleducação como uma estratégia do programa da hanseníase, um problema de saúde publica brasileiro. MATERIAL E MÉTODOS: Foram selecionadas 8 unidades sanitárias das diferentes regiões do município de São Paulo referência de tratamento em hanseníase. Nos casos suspeitos de hanseníase, os médicos destas UBS preenchem um formulário clínico, fotografam as lesões e as enviam via Internet ao Ambulatório Virtual, e também encaminham o paciente ao Ambulatório do HCFMUSP para avaliação presencial, sendo o padrão ouro e o teste o exame virtual enviado pela UBS. Planeja-se que até outubro cerca de 100 casos serão analisados sistematicamente e os resultados serão apresentados. Resumo: Esta apresentação visa mostrar a implantação de um serviço que utiliza novas tecnologias na rede pública de saúde como uma estratégia de programa de saúde. CONCLUSÕES: Se os dados mostrarem que o diagnóstico virtual é um método que auxilia o diagnóstico da hanseníase, o Ambulatório Virtual será ampliado para outras regiões como uma das estratégias do Programa da Hanseníase. INDICE/INDEX TELECONFERENCES IN PEDIATRIC RADIOLOGY- A BRAZILIAN'S NETWORK. 1 Monteiro, A.M.V. ; Junior, M.J.1; Santos, A.A.S.2; Neto, J.R.N.3; Cavalcanti, S.3; Sakuno, T.4, Nobre, L.F.N.4; Filgueiras, T5. State University of Rio de Janeiro- UERJ1, Fluminense Federal UniversityUFF2, IMIP-PE3, Federal University of Santa Catarina-UFSC4, Federal University of Minas Gerais-UFMG5._ BRAZIL. PURPOSE. To provide continuous pediatric radiology education among Medicals Schools and to centers over far distances. METHODS. Network teleconferences by electronically transmitting radiographic patient's images or power point presentations, session consultative and second opinion session by using ISDN or Internet II. RESULTS. The majority of the physicians were satisfied with the videoconference format, presenters and content. The consultations and discussions became more dynamic and organized. The medical and postgraduated students were more interested due to the new methodology and new researchs have been discussed. CONCLUSIONS. This pilot study in Brazil demonstrated that it is possible to engage Medical Schools in pediatric-radiology rounds by videoconference. Therefore, ongoing assessment of the use of videoconferencing for continuing education and the development of professional communities of practice is warranted to evaluate the impact of telehealth initiatives in our country. INDICE/INDEX TELECONFERÊNCIA COMO FERRAMENTA PARA DISCUSSÃO CLÍNICA ENTRE GRUPOS MÉDICOS À DISTÂNCIA Campelo, VES; Wen, CL; Pinheiro Neto, CD; Figueiredo, L; Bento, RF Universidade de São Paulo (FMUSP) Introdução: Compartilhar informações independentemente da localização dos usuários tem se tornado possível graças às modernas técnicas de telemedicina e abre novas dimensões para procedimentos diagnósticos e terapêuticos. Teleconferências realizadas entre centros de atenção à saúde de localidades distantes permitem maior integração e troca de conhecimentos que ajudam na resolução de casos difíceis e no estabelecimento de condutas. Objetivo: Descrever a experiência da Divisão de Otorrinolaringologia da USP com as discussões interativas via teleconferência. Material e Métodos: Foram desenvolvidas reuniões via IP (Internet Protocol) à 384 Kbps, bimestralmente em 2005, com a UERJ para discussão de casos clínicos. Utilizando conexão via ISDN (intergrated services digital network), a uma velocidade de 384 Kbps, foram realizadas teleconferências para discussão com a Mc Gill University (Canadá) em 2005. Utilizou-se equipamento do modelo Tandberg 6000 no ponto local. Resultados: Após vários testes, 384 Kbps foi definido como a velocidade padrão em que as imagens de alta definição e vídeos pudessem ser transmitidos com boa qualidade. A transmissão via ISDN à 384 Kbps mostrou uma estabilidade melhor do que a conseguida via IP a uma mesma velocidade. Após testes em horários variados, observou-se que a transmissão via IP tinha comprometimento da qualidade nos horários de maior congestionamento na rede, mas apresentava uma ótima qualidade nos demais horários. O custo da conexão via IP mostrou-se muito menor do que o necessário para conexão via ISDN. Conclusão: A teleconferência mostrou-se uma ferramenta viável e de boa qualidade para a discussão de casos e troca de experiências entre grupos médicos sem a necessidade de deslocamento dos participantes. Opção recomendada: Apresentação POSTER VERSÃO INGLÊSA DO RESUMO INDICE/INDEX TELEDENTISTRY AN EXPERIENCE USINGTHE INTERNET. Sequeira E.1; Chao L.W.1; Sgavioli,C.A.P.P2.; Carvalho I.M.M.2 (1) Discipline of Telemedicine, Medical School, University of São Paulo, São Paulo, Brazil. (2) Dental School, Sacred Heart University, Bauru, São Paulo, Brazil. In the health field, the technology helps to stimulate the student and the professional to improve their knowledge in a dynamic way. Supported by interactive resources and modernization of educational contents, students, professors and dental practitioners can use the benefits of technology to improve the quality of services provided to the population and professional improvement. Following the models developed and applied by the Discipline of Telemedicine of University of São Paulo, in 2004 and 2005, academic-scientific partnerships were established with dental schools, which allowed application of technology-based educational models, consolidating the Teledentistry in Brazil. By educational and technological support, professionals and students may learn at any time and place according to their dedication and availability. The Discipline of Telemedicine has tools as the “Cybertutor”, a Teleeducation environment, where the educational contents and the learning object “Virtual Man Project” are designed and applied, in which anatomic structures, threedimensional physiologic movements (height, width and volume), biomechanics, ultrastructures and temporal evolution are visualized by modernization of iconographies. Two titles were developed in Dentistry: temporomandibular joint and tooth structure. The Teledentistry facilitates the transmission, diffusion and exchange of information, being essential to support the professionals assisting the population. INDICE/INDEX TELEHOME MONITORING AVAILABLE TECHNOLOGIES Guzovsky, P.A. (MD) Medical Director - Panmédica Negócios Hospitalares Ltda.. São Paulo, S.P., Brasil. INTRODUCTION. The World Wide Web and the Telecom companies globalization, allowed several different approaches to Health, which originated the term Telemedicine. CONCEPT. One of the Telemedical areas refers to Monitor Patients at distance. Nowadays, an ideal format to the technologies would be: user friendly devices - connection through Telephone lines. - Wireless reception and transmission. - Miniaturization. - Possibility to communicate with Sound and/or Imaging. - Privacy INDICATIONS. Several Telehome monitoring indications where already published or presented, among them: AIDS Arterial Diseases Autism. Chronic Obstructive Pulmonary Disease Congestive Hearth Failure Continuous Education for Patients Dermatology Diabetes General Rehabilitation. Geriatrics Cognitive Disturbances. Hypertesion Medical evaluation Medication Mental Health Obesity. Oncology Pain management Post Trauma.monitoring Post-operative Sleeping diseases. Tecnologies: *Hardware: Coagulometer Digital Camera EKG Expirometer Glucosemeter Hearth rate Oximeter Scale Sphigmomanometer Thermometer *Software: - Web-based electronic medical records. - Case management. *Conectivity: - Telephony (POTS) - Broadband: DSL/Cable modem - Others. CONCLUSION. The available technology is enough to implement several telemedical projects and Industry is already investing in more efficient Softwares, to better manage the information gathered. Propedeuthics as we knew from the past changed by opening to modernization and the Classical Clinical Observation together with the technological evolution, is bringing an infinity of advantages, which at the end, targets the Individual well being. INDICE/INDEX TELE-MEDICAL COLLABORATION PLATFORMS DEPLOYED IN RURAL AND UNDERSERVED AREAS IN LATIN AMERICA Sachpazidis,I.; Kiefer², S.; Ohl, R.; Messina, L. A.; Sakas1 G. Fraunhofer Institute for Computer Graphics, Dpt. Cognitive Computing and Medical Imaging, Frauhoferstr 5, D-64283, Darmstadt, Germany; Fraunhofer-Institut Biomedizinische Technik, Ensheimer Straße 48, 66386 St. Ingbert, Germany; MedCom Gesellschaft für medizinische Bildverarbeitung mbH, Rundeturmstr. 12, 64283 Darmstadt, Germany; Messina Ltda, Vitoria Brazil KEYWORDS. Telemedicine, computer supported collaborative work (CSCW), teleconsultation, virtual private networks (VPN), Instant Messaging. ABSTRACT. T@LEMED project introduces an e-health model to the provision of health services in strongly underserved regions in Colombia and Brazil. The implementation of this model is supported on current telehealth technologies as well as on evidence based medicine. The target clinical applications include typical infectious diseases for the region such as malaria, and general ultrasound applications such as pregnancy control, urology and cardiovascular diagnosis. In Colombia two telehealth networks will be established that provide teleconsultation services to low level healthcare centres in rural and remote regions for the early diagnosis and treatment of malaria and other infectious diseases. The networks link experts in Cali and Bogota with lowlevel healthcare facilities in endemic, underserved regions at the Pacific Coast and in the Amazons region. The expert will evaluate diagnostic information such as microscopic images, medical device data and case reports in order to advice the local healthcare staff in diagnoses and treatment of the infected patients. As the technical backbone an extended version of the telehealth platform TOPCARE is used, that has been developed by Fraunhofer Institute IBMT and the Greek partners ICCS and Datamed in the context of the European Commission's research and development programme Technologies for the Information Society. In Brazil teleconsultation services for medical ultrasound examinations such as OB/Gyn, pregnancy control, urology and cardiovascular diagnosis are implemented for rural hospitals in Brazil by using the teleimaging platform, called TeleConsult, developed by Fraunhofer Institute IGD and the German partner Medcom GmbH. TeleConsult provides a wide spread of possibilities. It is able to acquire ultrasound images from an ultrasound device, to enrich a given image material with additional informations and to send it as a message to distant expert doctors connected to the medical network over Internet. With the help of TeleConsult two leading hospitals of Brazil; Santa Casa Hospital in Porto Alegre and the Hospital of the Federal University of Espirito Santo provide telediagnostics and treatment advices to rural hospitals and health centres. T@LEMED project has been funded by @LIS: Alliance for the Information Society, European Union Further information can be found at project's web site: http://www.alistelemed.net E-mail: [email protected] INDICE/INDEX TELEMEDICINA, O PRÓXIMO PASSO: A AVALIAÇÃO DO IMPACTO SÓCIO-ECONÔMICO? Medeiros, R.1; Wainer, J.2 1 Pós-graduando do Departamento de Informática em Saúde (DIS) da Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Professor Convidado do DIS/EPM; Brasil. RESUMO. Este artigo apresenta um resumo da pesquisa realizada sobre quatro projetos de telemedicina implantados no Brasil dois em Hospitais Privados e, dois ligados a Universidade Públicas. Nosso objetivo era o de encontrar resultados e evidências do impacto sócio-econômico conquistado com a telemedicina. A incorporação da avaliação como prática sistemática nos diversos níveis dos serviços de saúde poderia propiciar aos seus gestores as informações requeridas para a definição de estratégias de intervenção e melhorias no sistema de saúde (entendendo aqui a telemedicina como uma técnica de intervenção). Partimos da premissa de que os projetos de telemedicina só deveriam ser aprovados se estivessem acompanhados de um estudo rigoroso de viabilidade de médio e longo prazo, de um plano de evolução (da qualidade, dos custos, de acessibilidade e de aceitabilidade), além de sistema adequado e efetivo de difusão dos resultados, portanto, um contínuo processo avaliativo. Os impactos que deveriam ser avaliados, estão relacionados: a) impacto no processo clínico; b) na saúde do paciente; c) na acessibilidade ao sistema de saúde; d) econômico e, por fim e) impacto na aceitabilidade do sistema de saúde. A primeira constatação foi de que, ainda que a telemedicina tem trazido avanços para o debate nacional e crescimento dos sistemas de saúde, não há estudos ou avaliações dos projetos com qualidade e em número suficientes que garanta os benefícios potenciais da telemedicina e, por conseguinte, que possa produzir estimativas confiáveis dos seus verdadeiros benefícios. A segunda constatação é que, as relações entre as práticas e as necessidades de saúde podem ser apreendidas a partir de duas vertentes principais. A primeira delas consiste na busca dos seus significados econômicos, políticos e ideológicos, bem como da especificidade dessas relações em sociedades concretas. A segunda diz respeito à capacidade das práticas modificarem uma dada situação de saúde, atendendo ou não às necessidades de saúde de determinada população, ou seja, refere-se à discussão sobre suas características e seus efeitos. A telemedicina, neste sentido, surge como uma destas práticas que pode promover esta mudança, porém ainda não é esta a realidade encontrada, ou seja, não há mudanças concretas mapeadas e avaliadas. INDICE/INDEX TELEMEDICINA, UMA REALIDADE QUE O SUS, NO MUNICÍPIO DE SÃO PAULO, SÓ CONHECERÁ EM 2010!!! Medeiros, R.1; Wainer, J.2 1 Pós-graduando do Departamento de Informática em Saúde (DIS) da Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Professor Convidado do DIS/EPM; Brasil. RESUMO. Falar em implantar sistema de informação no setor público não é algo fácil, e em se tratando da rede de Saúde do Município de São Paulo as dimensões assumem proporções sem precedentes conhecidas, em função da sua complexidade. O grande desafio colocado ao município de São Paulo foi e está, em planejar e executar um projeto, que desse conta da informatização das suas Unidades a saber 386 Unidades básicas de Saúde, 98 Ambulatórios Especializados, 49 Policlínicas e 11 Ceccos. Diante deste cenário, uma das primeiras tarefas foi à escolha de uma metodologia para seleção do sistema e mecanismos de implantação que atendesse as prioridades político-administrativa do município. O resultado deste processo, concluiu com o desenvolvimento compartilhado com a iniciativa privada, norteado por premissas definidas centralmente (SUS) que determinaram o desenvolvimento do Projeto de Implantação do Sistema de Informação do município de São Paulo SIGA-Saúde Assim, o objetivo deste artigo é, apresentar ao leitor o processo iniciado em 2004, como o mesmo foi estruturado e quais os próximos passos, dado que não podermos afirmar que esta encerrado. Apresentaremos também, que a SMS-SP, privilegiou a utilização de conceitos, métodos, fóruns, equipamentos, recursos humanos e infra-estrutura já exSistentes na área de Treinamento e Capacitação dos seus colaboradores internos e do Ministério da Saúde MS, para a implantação do sistema. O artigo encerra com a constatação de que, o município de São Paulo, dado o atual cenário, terá condição de falar e investir em telemedicina somente a partir de 2010 e, de forma complementar apresentar as oportunidades para desenvolvimento da telemedicina no município. INDICE/INDEX TELEMEDICINE: A PERSPECTIVE FOR RONDÔNIA'S HEALTH Jakobi, HR Secretaria de Estado de Saúde de Rondônia CEREST/RO A powerful technological tendency is coming up, and will affect in a reversible way the medical practice. That is about Telemedicine, which are the technologies of telecommunication use to the interaction between health professionals and patients, in order to execute medical actions at distance. This will be a meaningful gain to the Amazon Region health, especially to our RondÔNia state, connecting remote places to the most advanced hospitals in the country and world, transmitting images, conferences, surgeries and other procedures which require the performance of experts in many different areas of health. Telemedicine can be thE most viable technical and economical solution to change the present deficient condition of the ambulatory and hospital medical services in our state. Its implantation and implementation in many regions, micro regions and in the municipal districts of RonDÔNia will generate a great potential to improve the health service to the population, increasing intensively the effectiveness of the health system, reducing the continental distances and the operational expenses. Patients will be able to have their infirmiTy diagnosed and treated in a faster way, causing less dislocation and suffering, better medical resolution and, consequently, reduction of the sequel rates. The technology analyzed in this study confirm that is extremely important and a great need to the Health professional staff to execute their daily tasks, concerning to the medical service to patients at distance, even if they are not in person in their offices and surgery rooms. The telemedicine contributes also to the formation, improvement and continUous preparation of the health professionals and the education of the population. The study demonstrates clearly that the infrastructure of the state presents very polarized aspects: while usufruct, for example, of a complete optical fiber to its fixed telEphonic communication, and on the other hand it lacks of highways with pavement and concrete bridges in many of its roads, making some municipal districts become isolated some time of the year, all of them are important as a way of flowing off the agriculture production and sick people; it has only 4% of basic sanitation in their homes, but it is assisted by cable TV and satellite. But what is essential to be understood is that Telemedicine is not only technology and new equipments but also a procedure that requires a lot of relevant organizational changes of the health service to be explored. There is evidence that Rondônia is very well served of necessary infrastructure to the Telemedicine achievement, being necessary only to have political determination and a Plan of Action in Telemedicine of Rondônia that has as a priority such technology. It is concluded that the technology of access utilization already existing (satellite, optical fibre and telephony), and a specific investment in hardware, software and peopleware will enable the Telemedicine project in our state. INDICE/INDEX TELEMEDICINE IN INDIA: STANDARDISATION ISSUES AND INITIATIVES Bedi, B.S. Senior. Director, Department of IT, Ministry of Communication & IT, New Delhi, India. ABSTRACT. India today has more than one billion population that is predominantly rural and distributed in distant geographical locations. Telemedicine assumes special significance for India considering 70% of the population lives in rural areas whereas about 90% of Secondary and tertiary health care facility are city based. Having the technical and medical expertise capability to offer quality healthcare to remote areas, a number of telemedicine centers have been set up and are also being planned across the country. To streamline establishment of Telemedicine centers and services, need for a set of standards and guidelines was felt. Through efforts of a specialized Technical Working Group, set up by Department of IT, Govt. of India, a nucleus framework of recommended guidelines and standards for practice of Telemedicine in India has been drawn up. The recommendations provide for setting up a Telemedicine center based on standards for systems, telemedicine software, connectivity, data exchange, etc. These are vital issues to be considered at this stage when Telemedicine activity is expanding rapidly in India and interoperability among diverse systems becomes a crucial factor for providing flexibility of multiple specialist consultations to Telemedicine nodes. The recommendations have been disseminated among various stakeholders who have evinced keen interest. In addition to bringing awareness among various stakeholders and policy makers, it is also provides guidelines for judicious adaptation of Telemedicine at different levels of existing landscape of health care delivery system prevailing in India. Majority of the vendors and Telemedicine solution providers in India have adopted the key recommendations making possible interoperability between diverse systems. Steps to take forward the present initiative of standardization activity in Telemedicine in India are also underway. INDICE/INDEX TELEMEDICINE IN OTOLARYNGOLOGY CONTINUOUS MEDICAL EDUCATION Campelo, VES; Chiari, JP; Voegels, RL; Wen, CL; Bento, RF Faculty of Medicine - University of São Paulo OBJECTIVES: describe a continuous educational program using a synchronic internet transmission of a course produced by Otolaryngology Department of University of Sao Paulo (USP). MATERIAL AND METHODS: this program is based on video streaming transmission of the Otolaryngology Extension Curse of USP. There are four remote centers (Campinas-SP, Santos-SP, Brasilia-DF, Salvador-BA) connected above 512Kbps broadband internet connection. The class transmission is acessed in a internet site (http://netsim.fm.usp.br/teleotorrino) and the user has two speed options: 100 and 300 Kbps. The students in the remote centers can ask questions using a chat, and the teacher answers online using the video streaming transmission. This improves the course interactivity with remote user participation. DISCUSSION: nowadays, one of the principal educational focus is the development of continuous programs that permit medical knowledge updating. This is difficult to be achieved by traditional methods, principally in the smallest cities, due to the shortage of human resources and the necessity of people dislocation. That project allows the transmission of expert classes to some remote points with appropriate quality, using a low cost and world-wide technology. Another advantage of the method is the experience exchange between the distant groups. CONCLUSION: video-streaming interactive based courses seems to be an efficient alternative in the development of continuous educational medical programs. INDICE/INDEX TELEMEDICINE IN PERMANENT MEDICAL TRAINING: AN INTERNATIONAL CO-OPERATION EXPERIENCE BETWEEN UNIVERSITY HOSPITALS CONNECTED TO PRIMARY CARE Alkmim, M.B.; DE-Lorme, P.; Santos, A.F.; Silva, I.M.; Souza, C.; Santos, S.F.; Peixoto, F.C.; Bossi, G.A.M. Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France; Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil; PRODABEL - Empresa de Informática e Informação do Município de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil The Telehealth and Telemedicine Nucleus of the “Hospital das Clínicas” (HC) of the Federal University of Minas Gerais(UFMG) promotes videoconferences with the “Centre Hospitalier Universitaire” (CHU) of Rouen, France, within an international co-operation agreement. Six medical specialities joined the program, carrying out clinical case discussions and exchanging experiences between the two institutions. The BH TELEMED project integrates these activities, as a telehealth project aimed at primary care for the family health teams, which links Health Centers from the Municipal Health Department of Belo Horizonte to the “Hospital das Clínicas” through a system of long distance consulting. With the integration of the used technologies, it becomes possible to connect doctors from the family health teams, in their work environment, to French and Brazilian specialists. International communications between the CHU/Rouen and the HC/UFMG are made through videoconferences using high bandwidth networks: RNP2 (MG/Brazil), RedClara (Latin America), GÉANT and RENATER (Europe). Local communications between HC/UFMG and health centers are made using computers, webcams and the network BH2 connection with the Municipal Computer network. Initially, in 2004, was established a simultaneous transmission to the CHU/Rouen and the health centers of the 1st Franco-Brazilian Medical Journey that took place in Belo Horizonte. From 2005 on, periodic clinical sessions made through videoconferences were structured in each speciality. There were 232 french and brazilian health professionals participating in the four events that took place. The interaction through Telemedicine between the national and international academy and primary care allows an unique form of permanent medical training, with doctors being trained in their own work environment, adding quality to the public health system. INDICE/INDEX TELEMICROBIOLOGIA: AVALIAÇÃO DO USO DE IMAGENS DIGITAIS EM BACTERIOSCOPIAS. Andreazzi, D.B.; Rossi, F.; Rosa, V.T.A.; Chao, L.W. Hospital das Clínicas de São Paulo-LIM-03; Disciplina de Telemedicina-FMUSP, São Paulo-SP, Brasil. INTRODUÇÃO: A bacterioscopia pelo método de Gram reflete características morfotintoriais importantes que podem auxiliar em diagnósticos precoces. A sistematização do diagnóstico através do uso de imagens de bacterioscopias geradas com máquina digital diretamente da ocular do microscópio e encaminhadas por email abre a possibilidade de diagnósticos à distância bem como o acesso a segunda opinião em tempo reduzido com relevante custo-benefício. MÉTODOS: 53 lâminas de materiais clínicos diversos foram analisadas por dois microbiologistas (M1 e M2). M1 fez as leituras por microscopia convencional (MC) e fotografou 5 campos relevantes gerando imagens digitais (ID) enviadas a M2 para leitura à distância. Para esclarecimento das discrepâncias uma terceira leitura foi realizada por M2 por MC com conhecimento dos resultados das leituras anteriores (leitura padrão). As ID foram capturadas com lâminas focadas sob a lente objetiva de 100x e ocular de 10x (aumento de 1000x), câmera Sony Cybershot Dsc-W5 com objetiva de macro, 3.2 megapixels, JPEG. RESULTADOS: 19% das lâminas (10/53) foram excluídas da análise devido a impossibilidade do diagnóstico por ID, sendo que 8% (4/53) das imagens apresentaram falta de foco e definição e, 11% (6/53), presença de material de fundo protéico que impediu a visualização das estruturas. O índice de compatibilidade (IC) entre a leitura de M1 por MC e M2 por ID foi de 81%. As discordâncias observadas foram avaliadas através da comparação dos resultados com a leitura padrão. O IC entre as leituras de M1 por MC x padrão foi de 93% (40/43). Das 3 lâminas discordantes observou-se 4 diferenças na identificação morfológica das estruturas relacionados a cocos Gram-positivos (1/4), diplococos Gram-negativos (1/4), leveduras (1/4) e a associação fuso-espiralar (1/4). INDICE/INDEX TELENURSING: PERMANENT TRAINING FOR PRIMARY CARE PROFESSIONALS IN THE CITY OF BELO HORIZONTE Guimarães, E.M.P.; Godoy, S.C.B.; Santos, S.F.; Nunes, A.A; Ribeiro, M.A.C; Maia, C.C.A.; Reis, M.C.S. Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brasil This is an intervention project of which take part the "Clínicas" Hospital and the College of Nursing of the UFMG, together with the Assistance Management sector of the Municipal Health Department of Belo Horizonte/MG, within a permanent training program, all of which are part of the activities of the TeleHealth BH TELEMED project. The proposal is based on carrying out long distance training sessions for the nursing teams of the basic care units of the city. The technology used is simple, computers, webcams and a communication software. Seventeen points have been installed in primary care units which can be connected on-line simultaneously. The TeleNursing sessions are scheduled beforehand, announced in the participating units, the confronted themes are selected by the professionals according to problems faced in daily practice. During the presentations, doubts are explained live by the person ministering the conference or by chat in an absolutely interactive process. Since the beginning of the activities, five meetings took place with an increasing participation of the nursing professionals of the primary units, a total of 241 individuals, that generally approved the used methodology. The obtained results achieved the goals established by the project and show that the use of long distance training is the most appropriate methodology to be implemented in the permanent training of the nursing team, considering the opportunity to discuss daily work processes and to overcome the limitations of participation in training activities that require a physical presence inside traditional educational places, that is, outside their work place and hours. INDICE/INDEX TELERADIOLOGY: IMAGING STRATEGIES AND PERSPECTIVES. Santos D.T.1, Sequeira E.2, Chao L.W.2 1 Department of Radiology, College of Dentistry, University of São Paulo, São Paulo, Brazil. 2 Department of Pathology, Telemedicine Discipline, College of Medicine, University of São Paulo, São Paulo, Brazil. The last few years have witnessed an increasing trend for secondary opinion interpretation services from medically less developed countries to centers of excellence. Teleradiology comprise the use of telecommunications and teletechnologies to deliver services to who are located in a different place from the radiologist, for purposes of interpretations and/or consultation. At present, international telemedicine and teleradiology represent a premium service, usually only available to wealthier people from those countries with less well developed health services. The premise is that telemedicine and teleradiology opinions may prevent unnecessary foreign travel by the patient to the centre of excellence. Often a diagnosis that has been made in the original country can be validated by the centre of excellence, thereby reassuring both the local physician and the patient. If an alternative diagnosis is suggested, treatment options can be suggested to the local physician who may also prevent the patient from traveling outside of their own country. The role of radiologist specialists can be enhanced from providing interpretations for diagnostic studies to supply advice on patient care and work-up. Teleradiology allows greater efficiency with sharing of services among institutions, greater standardization and reproducibility. The development as evidence-based health care is a new approach to this practice, where transdisciplinary collaboration is necessary through radiological practice, education, and research. INDICE/INDEX TELERADIOLOGY EXPERIENCE USING INTERNET AND WAVELET COMPRESSION Souza C.A. (*), Conrado M.A. Grupo Norteimagem Rio de Janeiro - Brazil The authors describe a solution that implements a secure teleradiology environment using Internet transmission and wavelet compression algorithms. The studies are acquired from different modalities, lossless or lossy compressed and dynamically stored in a central repository. There are Dicom and non-Dicom modalities, and different specialties (MR, CT, US, CR). The system is designed to allow authorized physicians and technicians to send and receive imaging studies from geographically distributed facilities, and review also at home/office, in order to provide specialty consultations and interpretations, regardless of distance or physical location. In each point there is at least one off-the-shelf computer, configured as a 'special workstation', with many features: thumbnail display of image series; support of color images and manipulation capabilities such as synchronized series scrolling, windowing/leveling, panning, zooming, line measurement, image flipping, rotating, and inverting; display/hide image text; JPG and BMP image exporting; automatic presets for CT and MR. The physician can filter the work list (by study Id, date, modality, patient, facility) and the selected exams are downloaded and can be reviewed. Once the interpretation is completed, the radiologist can create a report, save the results and synchronize with the server. The reports can be printed directly in each facility. The teleradiology solution is in use by a consultant group, integrating 5 radiology departments in small hospitals and outpatient clinics. INDICE/INDEX TELE-OPHTHALMOLOGY: REACHING-OUT FOR OUR PATIENTS. Ricur, G.; Zaldivar, R.; Batiz, MG Instituto Zaldivar. Mendoza, Argentina. BACKGROUND: Emerging technologies in communications are essential tools in healthcare, especially in countries were distances and easy accesses to qualified services are important barriers for patients. In this project coined FOCUS, our main objectives were to link our national and international branches, have real-time transactions between them, and offer added-value eye care services for our patients. METHODS: We developed a hybrid telecommunication network involving IP and ISDN connectivity, with several real-time applications: Electronic medical records (EMR) dataware house, intranet, voice over IP telephone system (VoIP), security system, videoconferencing system, as well as our institutional website. All these applications were used to enhance the communication of both personnel and patients, and increase our outreach. RESULTS: At present, we have effectively linked two of the three branches. The applications are based on our workflow, and run with their respective backup contingency plans in parallel. We are in the process of educating all the users, both in the institution as well as in the community. CONCLUSIONS: We now have different means of communicating ourselves within our organization and with our patients, which enables us to be more productive and efficient in providing high quality eyecare service, regardless of the distances. Although they have proven to be innovating and promising, cost-effectiveness has still to be demonstrated. INDICE/INDEX THE ROLE OF DISRUPTIVE TECHNOLOGY IN REDEVELPMENT OF MEDICAL SYSTEMS: TELEMEDICINE OF KOSOVA AS AN EXAMPLE 1, 2 2 2 3 Latifi R, Muja Sh, Bekteshi F, Merrell RC. 1. The University of Arizona, Department of Surgery, Trauma and Critical Care, Tucson, Arizona, USA; 2.Telemedicine Center of Kosova, Prishtina, Kosova; 3. Medical Informatics and Technology Applications Consortium, Virginia Commonwealth University, Richmond, Virginia BACKGROUND: The medical system of Kosova, a region currently governed by the United Nations and protected by NATO, was largely destroyed by1999, from Serbian forces, leaving behind severely damaged medical facilities and infrastructure. The telemedicine project was initiated to support, supplement and guide educational programs, and development of medical personnel in the region. Although seen as disruptive technology, telemedicine has become an import element in providing information resources for medical education programs within Kosova's medical system through regional and collaboration international. MATERIALS AND METHODS: Since its inauguration, Telemedicine Center of Kosova (TCK), on December 10, 2002, has concentrated its activities in creation of infrastructure, human capacity, clinical protocols, information resources, electronic library, and continuing medical education through regional and international collaboration. Fifty-four-thousand visits have been registered at the TCK by 1885 medical students and nearly 3000 doctors, nurses and other healthcare providers of the region. TCK has become virtual classroom of Kosova's medical system. As of march of 2005, 43 regional and international conferences have taken place at the TCK, including live broadcasts of complex surgical procedures. TCK has planted the seeds of medical information technology, and now is seen as champion of change and hope in a region devastated by war and neglect. CONCLUSION: Telemedicine may be regarded as a disruptive technology in well-developed and functional medical systems. However, when the disruption is war, natural or man made disaster; telemedicine can be an expedient way to achieve the goal of independent medical care when there is an acute need of recovery and redevelopment. INDICE/INDEX THE ROLE OF TELECARE IN THE PREVENTION AND SELF MANAGEMENT OF CHRONIC DISEASES Johnson, P. Telecare and Maternal Infant Research Centre, John Radcliffe Hospital, Oxford In the UK the Wanless review spelt out the need for a National Program for Information Technology NPfIT enabling a population to adopt a fully engaged scenario which meant the public using IT to self care; without this the NHS was unsustainable. The NPfIT (now called Connecting for Health), a major commitment to an expert patient program (EPP) (Stanford University) that identifies generic features of chronic diseases and the Kaiser Permanente chronic diseases severity pyramid by primary care could enable a radical change in healthcare. Innovative primary care teams have linked with social services and local authorities to utilise telecare to transform chronic disease management. Telecare combines health information, assistive technology as well as vital signs monitoring. Assistive technology is already being implemented for frail elderly patients with memory deficits by social services and intermediate care services to facilitate independent living through existing social alarm call services. However, this holistic strategy 'competes' with an inefficient costly hospitalbased specialist NHS model. How may these new and old service models be reconciled? Poor lifestyle and chronic diseases are increasing, especially for those socially disadvantaged. Nearly 1/3rd of the population now lives with a long term condition, a minority of who are diagnosed early or managed optimally. Many years of experience using continuous physiological recording in applications from antenatal care, through infancy to chronic conditions such as COPD, heart failure and sleep disorders has demonstrated that a combination of ECG heart rate variability (HRV), breathing (chest and abdomen ), and activity recorded over 24 hour periods is powerful generic diagnostic tool. It is an accurate individual guide to autonomic nervous system function, a risk stratifier for death and morbidity in many chronic diseases, and diagnostic of sleep-related cardiorespiratory disorder which complicates many chronic diseases (20% of diabetes, COPD to > 50 % of patients with CHF and hypertension). HRV has been increasingly used as an effective biofeedback tool in stress management programs (e.g. www.HeartMath.com ) which can reverse cardiovascular disease and as a marker of risk reduction and improvement of disease control. The generic clinical value of these measurements has led to the inclusion of suitable sensors into a wireless garment that can be easily worn by public and patients alike wherever they are in the community. The advent of blue tooth and GPRS mobile telephony has radically changed the scale and cost of providing a telecare service across the community. Blue tooth connectivity for an increasing number of individual sensors, such as oxygen saturation, blood pressure, means that additional measurements can be added as required using a mobile MDA platform to investigate and manage specific conditions. Experience using these continuous self monitoring technologies is that patients are compliant (90% of self made recordings are successfully completed) and develop more ownership of their clinical data The real challenge is how to package the results in a positive informing manner so that more people will understand and value engaging in healthy lifestyles. Equally health professionals in established health services where health promotion and risk reduction have not been priorities have to make radical changes in their knowledge base and practice. Innovative use of the internet, proving to be a powerful data acquisition tool and information resource, will be required to enable full advantage of the potential for self monitoring on a community wide scale. INDICE/INDEX THE USE OF TELEMEDIA INTERVENTION IN THE FIGHT AGAINST HIV/AIDS: IS IT WORKING? Molefi, M.L.; Kachienga, M.A.; Olurunju, S.; Moshela, M. Medical Research Council South Africa Telemedicine Lead Programme METHODOLOGY. The Mindset Health Channel that has been disseminating HIV/AIDS information via satellite is one amongst the few in the African content. This project is available in about 100 health facilities in South Africa. An evaluation of the broadcast HIV/AIDS content was conducted to test the effectiveness of this intervention. Questionnaires, interviews and observations were conducted amongst 167 participants/patients comprising of 2 groups - experimental and control, attending 4 healthcare facilities in 3 provinces in South Africa. The participants were exposed to different content. The Control - viewed a normal drama series of daily life while the Experimental watched a programme that focused on HIV/AIDS treatment and management. Data was analyzed using content, thematic analysis and descriptive analysis using statistics (STATA 8). RESULTS. The preliminary results showed that the intervention was found acceptable in terms of attitudinal and possible behavioral change. Positive results were noted with respect to understating the key medication areas such as (a) common side effects of the antiretroviral medication, (b) CD4 cell count and (c) willingness to disclose to family members. However there was marginal change in knowledge of the respondents on (a) why ARVs should be taken for life, (b) adherence and effects of not taking the pills and (c) unwillingness to disclose one's status to the community and to a spouse. CONCLUSION. Findings showed that there is evidence of positive change as results of this kind of programme however interpreting the side effects is still low. Stigma continues to be a major hindrance in HIV/AIDS disclosure. email [email protected] INDICE/INDEX THE VIDEOCONFERENCE AS AN EDUCATIONAL STRATEGY TO TEACH NURSING Leite M. M. J.; Peres H.H.C.; Kashiabara J. A. Nursing School of USP / Professional Orientation Dept, San Paulo/SP, Brazil The videoconference is an interaction among people in real time and among distant places. It has the purpose to communicate and it allows the use of sound, texts and images. It is considered a technology that is very similar to the traditional class, once it permits the interaction between the teacher and the students in real time. The aim of this study is to report the use of the videoconference as a strategy to teach the discipline Nursing Management III in the nursing graduation course of the Nursing School of USP (EEUSP). It is supported by the infrastructure of the discipline Telemedicine in the Medical School of USP This discipline is taught during the seventh semester, it has 315 hours and there are ninety students participating in it. The practicing fields were the School Hospital of USP, the Clinicas Hospital of the Medical School of USP and the School Health Center Samuel B. Pessoa. Seven meetings were done through videoconference connecting the three practicing fields. The students and the nurses made presentations with contents related to the management of the material, structure and human resources. At the end, the teachers gave a short speech about the themes discussed. Through the videoconference the students were given the opportunity to experience a new educational technology and they could also identify the possibilities and difficulties related to this strategy that brings a new educational space to the discipline Management in Nursing. The videoconference contributes to the interaction among the practicing fields and it allows the teachers, students and nurses to exchange experiences, which facilitates the learning process and it can also be combined with other educational methods like person to person and through distance.. e-mail: [email protected] INDICE/INDEX THE VIRTUAL WORLD IS REALLY VIRTUAL? Böhm, GM (Faculty of Medicine, University of São Paulo, Brazil) The real challenge of Telemedicine and e-Health is to guess what is going to happen in the future and how far this future is. Thus, for example, there are some doubts about surgery at distance whether it shall be an exception or a medical routine; however in the field of image diagnosis it is quite possibly that there will be nothing else but Telemedicine in a future that may be tomorrow. At present, almost everywhere whenever telediagnosis, teleassistance, tele-anything is mentioned some problems crop up: technical difficulties, economical burdens, legal and ethical aspects, patient-physician relationship and cultural aspects (exchange the real by the virtual world). The first mentioned problems are practically solved: Telemedicine is technically possible from a hospital localized in Washington DC to a mighty aircraft-carrier navigating in the Persian gulf; Telemedicine cost/benefit ratio is positive; Telemedicine's legal and ethical aspects have been studied and there are solid rules in many developed countries; the patient-physician relationship is a fundamental issue and it has a lot to do with the cultural aspects, however it must be always remembered that as virtual medical assistance is better than none. But it must be recognized that the main cultural difficulty of Telemedicine: its virtual stigma. IN THIS LECTURE the virtual aspects of the real world or, if somebody prefers, the reality of the virtual world, shall be discussed. It is generally recognized that cardiologists make unmistakable diagnoses by looking the electric signs of the heart. Is the examination of an electrocardiogram real? Are histopathological images less virtual when observed through a microscope than when analyzed on the screen of a computer? To see or listen something through a man made device is so much virtual than if an image or sound comes from a source directly in our eyes or ears? Most people accept that a binocular and a microphone belong still to the real world and the TV and cellular phone do not. But why? Is there any logic in this acceptance or it is only a superficial impression? Is the world less real to a bat than to a rat? The main question is whether there exists a real boundary between real and virtual. It is my personal opinion that the Real x Virtual problem is an ephemeral one; for the generation born digital it will be non existent and Telemedicine shall be part of our daily routine; it will be no more virtual than diagnosis through an electrocardiogram or to speak over a phone. INDICE/INDEX TOWARDS THE ENHANCEMENT OF A WEB ENVIRONMENT FOR SURGICAL SKILLS TRAINING ON OTOLARYNGOLOGY (WESST OT) Navarro Newball, A. A.- MSc1,2; Vélez Beltrán, J. A.- MD2,1; Múnera, L.E.S3.- PhD; Garcia, G. B.- PhD4 1. Pontificia Universidad Javeriana, Cali; 2. Colombia.Colombian Telemedicina Centre, Cali Colombia; 3. Universidad Icesi, Cali Colombia; 4. DITEC, Universidad de Murcia, Spain. KEYWORDS. surgery, simulation, virtual reality, otolaryngology, telemedicine INTRODUCTION. WESST OT's was designed to allow the practice of the Functional Endoscopic Sinus Surgery (FESS). The objective of the advances presented here is to enhance WESST OT in terms of realism, performance and functionality. METHODS. A collaborative, inter-institutional and interdisciplinary work and a modular approach has been followed under an object oriented methodology. RESULTS. Results are listed next: A stereopsis module was created aimed to provide 3D visualisations. A human systems module was created for the study of the anatomy used. A surgical tools module was created which allows the design of instruments. A surgical table was designed to allow the use of the instruments designed using the surgical tools module. A help system was implemented. Validations were done through the application of surveys in a medical community and performance was measured. The simulator was analysed from the technical and pedagogical point of view. The GOMS model for graphic interface efficiency measurement was applied. A strategy for the WESST OT validation in a Latin American network was designed. WESST OT is being extended with the use of a virtual reality glove, since it is a more natural interface. The co-ordination and the spatial positioning skills are under development. DISCUSSION. WESST OT demonstrates that cutting edge technologies like virtual reality can be used in Latin America via Internet; However, it requires further enhancement which increases its usefulness. Modular engineering not only contributes in the enhancement process of WESST OT but also, the modular developments have shown to be usable independently. INDICE/INDEX TRANSFORMING GOLDEN HOUR TO GOLDEN MINUTES FOR TRAUMA AND EMERGENCY CARE USING TELETRAUMA SYSTEM 1,2 1 2 3 Latifi, R.; Porter, J.; Holcomb, M.; Sproule, K.; 3 Young, E.; 3Thornby, D.; 2Weinstein, R. 1 Department of Surgery, Trauma and Critical Care Section, University of Arizona, 2Arizona Telemedicine Program, Tucson, Arizona, and 3Southeast Arizona Medical Center, Douglas, Arizona, USA BACKGROUND. Recent technological developments have made possible the implementation of teletrauma, telepresence, and teleresuscitation as integral part of modern trauma care. MATERIALS AND METHODS. The University Medical Center (UMC) in Tucson Arizona, USA, is the only Level I trauma center in the Southern Arizona and treats 4500-5000 trauma patients a year from all southern Arizona, northern Mexico, and other neighboring states. In collaboration with the existing network of Arizona Telemedicine Program (T1 line), the UMC has embarked on establishing the Southern Arizona Teletrauma (SATT) Program in attempt to narrow the gap of trauma and emergency care of patients in rural Arizona and to ensure telepresence of trauma surgeons 24/7 in all emergency rooms in the region. Using Vitel Net TM Teletrauma system for audio, video and electronic medical records transmission, Teletrauma system at the UMC has been active since November 21, 2004. The policies and procedures, educational programs and the protocols have been created and implemented to ensure standardization of the consultations and teleresuscitation. RESULTS. The initial experience with teletrauma in saving lives, managing critically ill and injured trauma patients at the rural site, or safely transferring when needed, and reducing the overall cost of trauma care has been rewarding and very successful. The acceptance by trauma surgeons, referring physicians, nurses, and other providers, as well as patients, has been excellent. Other clinical specialties are making preparations and creating protocols to use the system as well. The telepresence of trauma surgeon, through the teletrauma system is being used to identify knowledge gaps and the needs for instituting new outreach educational programs. CONCLUSION. Telepresence for trauma resuscitation can be performed successfully and safely using telemedicine principles, when guided by a trauma surgeon. This has transformed the trauma concept of golden hour to the golden minutestrauma surgeon. This has transformed the t ra u m a c o n c e p t o f g o l d e n h o u r t o t h e g o l d e n m i n u t e s . INDICE/INDEX UTILIZATION OF WEB-BASED TELECARE IN DENTISTRY Marta S.N.1; Sgavioli C. A. P.P.1; Sequeira E.2; Veronezi M.C.1; Chao, L.W. 2; Ferreira E.G.P.1 (1) Sacred Heart University, Bauru, São Paulo, Brazil. (2) Discipline of Telemedicine, Medical School, University of São Paulo, São Paulo, Brazil. The web-based telecare (cyberclinic) for consultation purposes in Dentistry aims at integrating resources to promote the learning and professional updating during clinical practice, allowing its utilization in several areas of the country as a tool for support to interconsultation, in family health programs, basic health centers, health campaigns and as a tool for long distance triage. Developed by the discipline of Telemedicine of the Medical School of USP, with support of the Teledentistry Sector of Universidade do Sagrado Coração (USC), the system presents several modules: for sending and evaluation of clinical cases; diagnostic support and updating of the professional; drug bank with drug interactions; epidemiological surveillance data collection. As a pioneer system in the field of Dentistry, besides utilization with undergraduate and graduate students, USC has also established partnerships with some institutions, such as Health Secretariat of Bauru, APCDBauru, and APAE-Jaú, and attempted to regulate its utilization with CRO-SP. The following was performed: 1) 6 trainings for utilization of the tool with students and partner institutions; 2) at APAE-Jaú: reformatting of records, base don the clinical form proposed in the cyberclinic and presential examination of the 50 students of the institution, which in the future will allow co-validation of the data sent by web; 3) submission of 20 cases among the professors registered, which allowed correction of some failures and improvement of the system. Its large scale utilization will be a resource for updating and close contact between former students and teaching centers of excellence, to benefit the patients. INDICE/INDEX “VIRTUAL CONSULT” Ricur, G.; Zaldivar, R.; Batiz, M. G. Instituto Zaldivar. Mendoza, Argentina. BACKGROUND. The new cyber era has enhanced global communication and provided new opportunities for accessing medical care and knowledge. IP and video-conferencing technologies have brought together both patients and doctors regardless of their distances. The objective of our project was to provide eye care services, both online and thru video-conferencing systems between our branches, enhancing our patient outreach. METHODS. Thru a hybrid telecommunication network, involving IP/ISDN connectivity and videoconferencing systems, our patients had the chance to either consult our specialists online or be examined at our telemedicine suite in Buenos Aires by the consultants in Mendoza. These virtual ophthalmic consultations were analyzed retrospectively measuring the impact of the use of these new technologies with protocols designed specifically for this project. RESULTS. Since its implementation, 5707 online consultations have been registered and 267 teleconsults (video-conference) have been performed between Buenos Aires and Mendoza. CONCLUSIONS. Information and telecommunication technologies play a key role in this new digital era. They have enabled the medical community to enhance its outreach. Nevertheless, regardless of the tools used, virtual consultations are ordinary consultations: physically different but ethically the same. Further development of standards and guidelines are required to help maintain virtual consultations safe from the never-ending growth of emerging technologies. INDICE/INDEX VIRTUAL MAN PROJECT IN DENTISTRY Soares, S 1; Sequeira, E. 2; Malmström, M.F.V. 1; Castilio, D.1; Chao, L.W.2 1- Dentistry course, Sacred Heart University, Bauru, São Paulo, Brazil. 2- Discipline of Telemedicine, Medical School, University of São Paulo, São Paulo, Brazil. The Virtual Man Project of Discipline of Telemedicine from São Paulo University, based on the concepts of learning objects, makes images with movements of high visual and didactic quality, developed by collaboration between health specialists and digital design professionals. In Dentistry, two titles were prepared up to 2005: Temporomandibular Joint and Tooth Structure, made by an association of the Discipline of Telemedicine FMUSP and Sacred Heart University. After selection of a topic, an educational guide is developed and scientific bases are searched for construction of each image. The digital designers of the Discipline of Telemedicine FMUSP transform the information in graphic representation. The threedimensional images (height, width and volume) allow visualization of anatomic structures with physiologic or pathologic movements. The possibility of three-dimensional visualization, establishment of anatomic correlations, utilization of transparency resources, subtraction (exclusion) and inclusion of functional dynamics, transforms the “Virtual Man” generated model in an absolutely new way of transmitting a large amount of information in a short time, increasing the educational efficiency. After conclusion of the work, these images are used to help the learning of students and training of professionals. The perception of students and professors of USC in relation to this tool was positive. The development of modern iconographic resources facilitates the education. INDICE/INDEX (1) WEB-BASED FRAMEWORK FOR MANAGING THE OFFICIAL MEDICAL CHECKS Fregonara M. (1), Lombroso F.(1) Azienda Sanitaria Locale Provincia di Milano 3; Monza (Milan); Italy One of the purposes of the Italian Local Health Authority (LHA), for territorial health and social services, is to execute the Official Medical Checks (OMC) asked by private and public Companies on sick employees suspected of fraudulent ill-health. The LHA must guarantee that an OMC is performed by an official Medical Examiner (ME) within two days. There is a complex workflow to manage in terms of bureaucracy and health problems. The present project aims at creating a web-based framework to fully manage the OMC workflows and to realise a database of all linked information (organisation, healthcare, administrative and repayment). The framework replaces the paper-based procedures with a similar process supported by information and communication technologies. The framework architecture is fully web-based, developed with web-programming languages, organised in three layers technology and divided into three networks: Internet connects the Companies; Extranet connects the MEs; Intranet connects all the LHA operators. A Company can request an OMC on its employees among the citizen in the LHA database, via Internet. The framework certifies the correctness of the personal data by verifying it in the register of births. The LHA operator accepts the request and appoints it to the nearest ME where the employee lives. The framework automatically assigns a Medical Check ID (MCI) and sends to the Company an email, confirming the acceptance of the request, and to the selected ME an email and a SMS (Short Message System) with all the OMC information (personal data, address, MCI, etc). After the visit the ME inserts, via Extranet, all the sanitary and operative information (diagnosis, healthcare status, employee presence at home, etc). The framework automatically sends to the Company an email containing the results of the OMC request. Then a LHA operator inserts the administrative information for the ME charge and for the repayment by the Company. The Companies can verify, via Internet, anytime the workflow status of all their requested OMCs, the LHA operators can check, via Intranet, the status of all the OMC workflows and its related information, and also all the MEs can verify, via Extranet, their assigned OMCs and related information. information. Other framework features are the complete integration with the LHA Account Software, so the OMC repayment information and the ME charge are immediately processed, and the management, analysis and reporting of all the health OMC data. Particular care has been devoted in the framework to the safeguard of the citizen' privacy. Since summer 2004, the framework is running successfully (31655 requests by 6372 Companies for 24013 employees) for submitting OMC requests, for global managing of its workflows and for analysing all its information (organisational, administrative, healthcare and repayment). The proposed framework represents a demonstrator of a possible usage of ICT technologies to improve and to spread health and social services. INDICE/INDEX LEVELLING THE PLAYING FIELD - THE ROLE OF GLOBAL E-HEALTH IN ADDRESSING INEQUALITY AND INEQUITY Dr. Scott, R.E. President, Canadian Society of Telehealth Harkness Associate; Fulbright New Century Scholar Alumnus Given the networked nature of e-health (health informatics + telehealth), the ultimate culmination of our individual and collective e-health related activities will be to truly develop the entity of 'global e-health'. However, it is already recognised that e-health represents both promise and peril as it is applied in addressing various 'divides'. One such divide relates to the health of individuals, and the health status of populations, which vary widely. A number of factors contribute to this variation, including socio-economic status, occupation, gender, age, ethnicity, culture, behaviour, geography, healthcare practice ('small area variation'), healthcare administration, disease prevalence, and poor global health information flow. When significant imbalance occurs, such variation is often termed inequality or inequity. These terms are sometimes used interchangeably, but their differentiation is important. Inequality and equality have been described as dimensional concepts that refer to measurable quantities. In contrast inequity and equity are considered political concepts that express a moral commitment to social justice. According to EQUINET, inequity in health is “those differences in health status that are unnecessary, avoidable, and unfair”. Inequality in healthcare is not an issue for developing countries alone - a significant disparity has always existed in developed countries in terms of geographic location. Those who live in an urban area have greater and timelier access to healthcare services than do those in rural or remote areas. The impact in terms of inequality and inequity - can be profound. The situation is compounded in developing countries that must also struggle with fundamentally poor healthcare infrastructure and funding constraints. Opportunities to overcome, or at least minimise, sources of inequality and inequity already exist at the practice, program, and policy levels. Can global e-health contribute to the process? The simplistic response is absolutely. Global e-health has the potential to address causes of inequality directly, and thereby address inequity indirectly. For example, small area variation across subgroups of practitioners may be identified as a factor contributing to inequality. A variety of e-learning options exist (training, mentorship, continuing education) that, if determined to be appropriate, can be implemented through specific voluntary or mandatory educational (practice), training (program), or standardisation (policy) interventions. But issues also arise. For example, e-health has the potential to exacerbate as well as ameliorate inequality to broaden the 'digital divide' (and other divides). Poorer people are generally most in need of healthcare support, yet they are the group least likely to have access to rapidly advancing technological solutions. Our challenge is to identify, develop, and apply culturally appropriate, broadly available e-health solutions, and to concurrently develop the population and professional skills necessary to use them. In this regard, global e-health alone will not suffice. To impact other determinants that affect individual and population health, such as literacy and employment skills, it will be necessary to develop initiatives that work in concert, developing e-learning and e-business opportunities concurrently with e-health applications. To achieve this, a systematic approach is required. One that includes: identification of the magnitude of health gradients, needs and readiness assessment, determination of whether e-health is a viable option, and finally implementing and assessing the impact of any global e-health solution. Such a process would be equally applicable and valuable to developing countries as to developed countries, but the context and solutions would be different. Applying this approach will allow appropriate e-health solutions to be applied in reducing inequality and inequity wherever it is found, and thereby help level the playing field for the health of the world's population. INDICE/INDEX INDICE/INDEX