Perceived usability of a store and forward telehealth platform for diagnosis and management of oral mucosal lesions: A cross-sectional study.

EstomatoNet was created in the south of Brazil to provides specialist support over a web-based platform to primary care dentists for diagnosis of oral lesions. To evaluate the usability of EstomatoNet and to identify user perceptions regarding their expectations and difficulties with the system; and to compare the perceptions of regular users of the service to those of first-time users. Sixteen dentists were selected for the study: 8 were frequent users of EstomatoNet and 8 were residents who had never used the Platform. To assess usability, participants were required to request telediagnosis support for a fictional case provided by the research team. During the process of uploading the information and sending the request, users were asked to "think out loud," expressing their perceptions. The session was observed by an examiner with remote access to the user's screen (via Skype). After the simulation, users completed the System Usability Scale (SyUS), a validated tool with scores ranging from 0 to 100. The mean SyUS score assigned by frequent users was 84.7±6.6, vs. 82.2±9.3 for residents (satisfactory usability: score above 68). The difference between the groups was not statistically significant (Student t test, P = .55). The residents group took longer (347.1±101.1s) to complete the task than frequent users (252.8±80.3s); however, the difference between the groups was not statistically significant (Student t test, P = .06). In their subjective evaluation, users suggested the inclusion of a field to add further information on outcomes and resolution of the case and changes in the position of the "Send" button to improve workflow. The present results indicate satisfactory usability of EstomatoNet. The Platform seems to meet the needs of users regardless of how experienced they are; nevertheless, a few minor changes in some steps would improve the tool.

The use of telemedicine to support Brazilian primary care physicians in managing eye conditions: The TeleOftalmo Project.

PURPOSE: To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. METHODS: We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. RESULTS: Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged ≥65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001). CONCLUSIONS: With telemedicine support, primary care physicians solved over two-thirds of patients' eye or vision complaints. Refractive errors had high case resolution rates, thus having a great impact on reducing the number of referrals to specialty care. Teleophthalmology adoption in primary-care settings as part of the workup of patients with eye or vision complaints promotes a more effective use of specialty centers and will hopefully reduce waiting times for specialty referral.

Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI / Telehealth as core of 21st century universal health care systems / Telesalud como eje organizacional de los sistemas de salud universales del siglo XXI

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

New epidemiological and demographic challenges require new ways of organizing healthcare systems. This essay proposes telehealth as an organizational tool, capable of smoothing the iron triangle of health care and facilitating achievement of the triple aim, namely greater access and quality with cost reduction. The integration of telehealth into the referral process and the transition between care services increases the resolvability of primary health care (PHC), facilitates the coordination of care, promotes treatment adherence, decreases readmissions, and stimulates quaternary prevention. This essay introduces the notion of telehealth as a meta-service that confers technological density to PHC and allows it to become an effective coordinator of care, organizing the flow of information, people and supplies. In view of the innovations proposed, it is essential to evaluate the impact of existing telehealth initiatives so as to extend their applicability as meta-service.

Nuevos desafíos epidemiológicos y demográficos demandan nuevas formas de organizar los sistemas de salud. El presente ensayo propone la telesalud como herramienta organizacional, capaz de suavizar el triángulo de hierro de la atención a la salud y de facilitar la búsqueda por el triple aim, por su potencial de aumento del acceso y calidad con reducción de costo. La integración de la telesalud al proceso de referencia y transición entre servicios asistenciales aumenta la capacidad resolutiva de la Atención Primaria a la Salud (APS), favorece la coordinación del cuidado, promueve la adhesión terapéutica, disminuye reinternaciones y estimula la prevención cuaternaria. Este ensayo propone la telesalud como metaservicio que confiere densidad tecnológica a la APS y permite que ella se convierta en coordinadora efectiva del cuidado, pasando a organizar el flujo de informaciones, personas e insumos. Frente a las innovaciones propuestas, es esencial evaluar el impacto de acciones ya existentes de telesalud para viabilizar su aplicación como metaservicio de salud.

Teleconsulta: nova fronteira da interação entre médicos e pacientes / Teleconsultation: new frontier of the interaction between doctors and patients / Teleconsulta: nueva frontera de la interacción entre médicos y pacientes

A teleconsulta, uma ação de telessaúde, apesar de ser regulamentada em vários países, ainda não é permitida no Brasil. O presente texto explora a situação da teleconsulta na América do Norte, na Europa e em outros países, fazendo um paralelo com a situação nacional dentro da medicina e de outras profissões da saúde. Ao final, por meio do referencial utilizado, é construída uma argumentação de forma a assumir um posicionamento favorável à regulamentação da teleconsulta no país.

Teleconsultation, a telehealth action, although regulated in several countries, is still not allowed in Brazil. This text explores the topic of teleconsultation in North America, Europe and other countries, parallel to the national reality in medicine and other health professions. Finally, from the theoretical framework analyzed, an argument is built to assume a favorable position to the regulation of teleconsultation in the country.

La teleconsulta, una acción de telesalud, a pesar de ser regulada en varios países, todavía no es permitida en Brasil. El presente texto explora el tema de la teleconsulta en América del Norte, en Europa y en otros países, haciendo un paralelo con la realidad nacional en la medicina y otras profesiones de la salud. Finalmente, a partir del marco teórico analizado, se construye una argumentación para asumir un posicionamiento favorable a la regulación de la teleconsulta en el país.