A web application to support telemedicine services in Brazil.

A Web Application to Support Telemedicine Services in Brazil Ana Karina P. Barbosa(1), M.Sc.; Magdala de A. Novaes(2), PhD; Alexandre M. L. de Vasconcelos(3), PhD (1) Master, Researcher of TIS, Federal University of Pernambuco (UFPE), (2) PhD, Associate Professor, Clinical Medicine, Federal University of Pernambuco (UFPE), Researcher and Coordinator of the Research Group on Information Technologies for Health (TIS), (3) PhD, Associate Professor, Clinical Medicine, Federal University of Pernambuco (UFPE), Informatics Center, TIS/LIKA-UFPE, Av. Prof. Moraes Rego S/n, Cidade Universitária, Recife-PE, 50.670-901, Brazil, Tel. +55 81 32718489, Fax +55 81 32718485 Abstract This paper describes a system that has been developed to support Telemedicine activities in Brazil, a country that has serious problems in the delivery of health services. The system is a part of the broader Tele-health Project that has been developed to make health services more accessible to the low-income population in the northeast region. The HealthNet system is based upon a pilot area that uses fetal and pediatric cardiology. This article describes both the system’s conceptual model, including the telediagnosis and second medical opinion services, as well as its architecture and development stages. The system model describes both collaborating tools used asynchronously, such as discussion forums, and synchronous tools, such as videoconference services. Web and free-of-charge tools are utilized for implementation, such as Java and MySQL database. Furthermore, an interface with Electronic Patient Record (EPR) systems using Extended Markup Language (XML) technology is also proposed. Finally, considerations concerning the development and implementation process are presented. 1. Introduction The complexity that characterizes health information management has motivated enterprises and institutions to develop technological solutions to hasten and improve the quality of patient attendance, to prevent diseases and foster greater health awareness. In Brazil, the high costs of diagnosis and therapeutic procedures, the lack of control of service usage, the growth in, and aging of, the population are some of the problems affecting national public health. Apart from these issues, the large concentration of health services in urban areas, the lack of specialists in more remote areas and the low number of professionals trained in family medicine have made health delivery less accessible to poor people. The Brazilian government has taken stock of this situation and has started to invest in pilot projects to evaluate Telemedicine usage as a complementary tool to health services by considering both national and international experiences 1,2,3 . One of these initiatives is the Telehealth project, which is to be deployed in Pernambuco, a state in the northeast of Brazil. The HealthNet system4 described in this paper is the core of this project. This integrated system was defined to support Telediagnosis and Second Medical Opinion. The HealthNet Telediagnosis service will allow health practitioners who live in rural, out-of-theway places, to interact with medical specialists in order to correctly diagnose their patients. The interaction will be digital, thus eliminating the need for participants to travel. The connection with a Health Reference Center will initially be made via Integrated Services Digital Network (ISDN) channels and subsequently via the Internet. The HealthNet Second Medical Opinion service will allow doctors in Reference Centers that are geographically separated to cooperate in clinical patient cases. The main benefits of this service are its potential to reduce treatment costs as well as the incidence of risks and errors. In the HealthNet environment, doctors will be able to discuss patient cases though the second opinion service with other doctors . The patient cases will be generated via the Telediagnosis service or they will be generated by the doctors who collect data within their own institution. Generally uncommon cases or cases that comprise more than one medical specialty are dealt with in collaboration. The Reference Centers will be connected through an Asynchronous Transfer Mode (ATM) network and will form what will be called an Integrated Network of Cooperation in Health. AMIA 2003 Symposium Proceedings − Page 56 2. Methods Fern and Pediatric Cardiology were chosen to be the pilot area to the project. This area has large social repercussions and presents situations where attendance must be immediate in order to diagnose, plan and treat many serious cardiac diseases. The system’s conceptual model regarding remote diagnosis and second medical opinion was based upon requirements obtained by a literature review of Telemedicine development and system usage, and on information collected from both sides of the attendance: the basic service and the Reference Center, in this case the Fetal and Pediatric Cardiology Unit (UCMF) at the Real Hospital Português, one of the partners in this project based in the state capital, Recife. At first, a system model prototype5 was implemented using Delphi language working in a point-to-point network using ISDN channels Through this system a health-worker could send patient information by e-mail to a Reference Center in order to be evaluated by a medical specialist. The patient data was organized into demographic data and clinical cases. The application was customized to allow the capture of images and videos of echocardiography examinations which could then be attached to patient case history. The application was deployed and tes ted at Saint Efigênia Hospital in Caruaru, 136 km inland from Recife, the state capital. Telediagnosis service requests were made to the Fetal and Pediatric Cardiology Unit at the Real Hospital Português in Recife. This initial experience revealed that the transmission of multimedia data is effective in the diagnosis of congenital cardiology diseases in patients. It was clear from the results obtained from this first prototype and a more detailed requirement analysis that apart from having a tool capable of supporting remote diagnosis others would also have to be developed in order to manage Telediagnosis and to manage medical second opinion. This is particularly the case once the Telemedicine system has been incorporated into clin ical practice. This kind of system could also generate relevant information for the public health information system. In this new context HealthNet was proposed. Reference Center to have its own database and independent telediagnosis services, thereby guaranteeing institutional autonomy. To support this architecture, two subsystems were designed: HealthNet User and HealthNet Manager6 . HealthNet User is the subsystem installed in each Reference Center that interacts directly with the user. The HealthNet User itself is a complete and independent system which supplies Telediagnosis services and internal s (...truncated)