President Jair Bolsonaro (PL) sanctioned this Tuesday (27) the law that regulates the practice of telehealth in Brazil and establishes criteria for distance care. The text had been approved by the Chamber of Deputies on the 13th.
Telehealth encompasses, in addition to medicine, remote care in nursing, physiotherapy and psychology, for example. The modality was allowed on an emergency basis during the Covid-19 pandemic, in 2020, and from 2023 it will be within a new portfolio that will be created in the management of president-elect Luiz Inácio Lula da Silva (PT) and headed by the professor and former first lady of São Paulo Ana Estela Haddad.
Among the rules established by the new legislation are the autonomy of the health professional to decide on the use of the practice, including in relation to the first consultation.
It also guarantees the patient’s right to refuse care in the distance modality and the confidentiality of data.
The acts of the health professional will be valid throughout the national territory, and the federal councils will be responsible for the ethical regulation of the provision of remote services.
In addition, a rule that intends to restrict telemedicine must demonstrate the indispensability of the measure so that damage to the health of patients is avoided.
The new law was celebrated by the health sector. In a note, Fenasaúde (National Federation of Supplementary Health), which brings together 14 groups of health plan operators (41% of the market), said that the new law represents a breakthrough and will expand access in the country. Since March 2020, Fenasaúde members have carried out more than 11 million telehealth consultations.
For physician Caio Soares, chairman of the board of directors of the Brazilian Association of Telemedicine and Digital Health Companies, the law is very positive. “The text was much discussed for two and a half years with civil organizations and class councils and reflects current needs well.”
The fact that the legislation adheres to the basic principles for the provision of services and leaves open some technical issues that need to be much more discussed is another gain, according to Soares, because, otherwise, it would be born in a cast.
Among the issues are the format and model of electronic prescriptions and which environments, other than offices, telemedicine can be practiced. For example, there is a discussion about whether virtual consultations can take place inside malls, supermarkets and pharmacies.
Currently, for example, medical appointments are not allowed inside pharmacies. These limits should be discussed within the framework of Anvisa (National Health Surveillance Agency) and the Federal Council of Medicine.
According to the norm, the registration of intermediary companies of medical services is mandatory, thus considered the legal entities that directly or indirectly hire medical professionals for the exercise of telemedicine, as well as the registration of a medical technical director of these companies, in the regional councils of medicine in the states where they are headquartered.
There are currently more than 100 companies practicing telehealth in the country, not counting startups, according to data from Saúde Digital Brasil. In 2021, 14 million teleconsultations were carried out. The expectation is that 2022 ends with 30 million.
“Next year, this should continue to grow because the recurrence rate is very high. Of those who use it once, 80% go back to using it again. Doctors who were still resistant during the Covid-19 pandemic, have become users of the tool.
Data from the entity show a resolution rate of 94% for teleconsultations. That is, only 6% of cases are referred to an emergency room or to a specialist with face-to-face assistance.
The expectation is that, from this new law, there will be an expansion of telehealth services also in the SUS. According to Zeliete Linhares Leite Zambom, president of the Brazilian Society of Family and Community Medicine, the proper use of the tool in primary health care will increase access.
“There are many trivial day-to-day issues that could be resolved more easily by teleconsultation, the person would not need to go to the health unit and spend hours waiting for assistance.”
She points out that primary care provides longitudinal care (over time) and planning to coordinate people’s care, which can be difficult with distance services, in addition to cases that necessarily require face-to-face care.
“But it could also be the moment to make a connection with people who cannot reach a health unit. Today we have a clientele that goes far beyond our capacity.”
The doctor reinforces, however, that it will be necessary to evaluate and adapt to the realities of each location. For example, there are people who do not have smartphones and who will not be able to receive or make video calls.
For Chao Lung Wen, head of the telemedicine discipline at the USP Faculty of Medicine, higher education must adapt to the new reality. “When it becomes law, basically, all health faculties and medical and multidisciplinary residencies will need to include telehealth as a mandatory subject, as it is the function of institutions to teach about SUS”, he said in a note from USP.
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