The Brazilian Telemedicine University Network

After providing telecommunication infrastructure to over 350 education and research institutions, helping an estimated public of over a million users, and linking all the Brazilian regional academic networks, RNP is looking to build user communities. At the beginning of the century, there was still no integration of Brazilian eHealth communities nor was there a national consensus. Isolated projects started in the late 90s.

The Brazilian Telehealth initiatives achieved their federal ministerial integration stage as the National Health Ministry, MS – Ministério da Saúde; the Permanent Commission of Telehealth, created in March 2006; and in January 2007 the National Telehealth Program in the Primary Care. These acts followed the first initiative of the Brazilian National Science and Technology, MCT – Ministério da Ciência e Tecnologia, to establish a Telemedicine University Network called RUTE – Rede Universitaria de Telemedicina. This network was to be based on the implementation of telecommunication infra-structure in the University Hospitals, starting in January 2006.

A particularly important initiative is the Brazilian Telehealth National Program. In its first phase, it applies to nine states Amazon, Ceará, Pernambuco, Rio de Janeiro, Minas Gerais, Goias, São Paulo, Santa Catarina and Rio Grande do Sul and uses as reference centers the nine University Hospital members from the Telemedicine University Network-RUTE. These are all already equipped with TICs infra-structure and Videoconferencing systems, running education and collaborative research works alongside European institutions. These are being improved, increased and stimulated.

In order to promote the expansion of Tele-health Clusters in the States not yet participating in the National Tele-health Project in the first stage, a two point strategy of high speed Internet access and infrastructure is being implemented. With hopes to hereby achieve an initial nation wide health care network in all Brazilian states.

An ongoing project in Brazil, run by RNP – Rede Nacional de Ensino e Pesquisa, is building Metropolitan Area Networks (MANs) on the 27 state capitals where RNP has its PoPs (Redecomep, Education and Research Community Network ). The purpose of this project is to connect all major public universities and research centers in the country with optical fibers owned and managed by local consortia formed by these institutions and RNP. The initial capacity that will be available for the member institutions on each MAN is 1Gbps based on Gigabit Ethernet optical switching technology. Those MANs are being established at this time, already operational in 10 state capitals, and they are expected to be fully operating by 2010.

On top of this infrastructure the network is being prepared to support specific areas such as health with telemedicine, grid computing, and high energy physics, to give some examples. The health area is showing the most interest and feasibility. The project Rute1 - Rede Universitária de Telemedicina ( Telemedicine University Network ), funded by the Ministry of Science and Technology, is building and updating the application-level infrastructure of 19 university hospitals, in the major cities of the country. The project goal is to allow all participating hospitals to use RNP network in order to run telemedicine and telehealth applications including video conferencing for information exchange, second opinion, continuous education and web conferencing. It builds the basis for the interhospital collaboration.

Additional funding, also by the Ministry of Science and Technology, has been approved to expand the Rute project to include 38 more university hospitals and health universities, and therefore connect all the 45 public federal university hospitals in the country. This would yield a telecommunication and Telehealth infrastructure project of 57 health institutions. RUTE, the Telemedicine University Network is now represented in every Brazilian state. As part of the RUTE project, a council was established, including members of the major university hospitals, RNP, the Brazilian Association of University and Education Hospitals, a representative of each Ministry of Health, Education, Science and Technology and FINEP, the National Funding Agency for Projects and Studies, to discuss and define the policies, procedures and all ubjects related to the use of the Telemedicine Network.

Conclusions
A recently approved expansion for RUTE 2009 will benefit certified educational public hospitals and federal health institutions. They are to include: cardiology, oncology, rehabilitation, orthopedic and trauma, deaf, hearing impaired and blind, and Indian health Around new 50 eHealth Centers are to be established and integrated to the Telemedicine Network University. The main objectives hereby to be attained are: stimulate certification procedures and the use of Telehealth technologies, optimise formal and remote education of the health family program, and deliver precise assistance in remote diagnosis and treatment to undeserved regions in Brazil.

Each RUTE institution receives benefits and provides:
• Connection to the Network PoP to 1Gbps in the MANs
• Telemedicine and Telehealth Center
• Videoconference Room
• Teleconsult and Telediagnostic room
• Telehealth courses
• Participation in Special Interest Groups SIGs

The SIGs in operation are: Telehealth Standards, Quality and Security in Hospitals, Radiology and Image diagnosis, Child and Adolescent Health, Dermatology, Ophthalmology, Pediatrics Oncology, Aids, Rural Assistance, eHealth Innovation
R&D, Nursing, and Psychiatry, among others. There are today already 23 University Hospitals fully operational in 14 federal states. With the additional resources from Health Ministry in the Telehealth National Program, 9 RUTE Telehealth Centers assist 2900 teams. In a partnership with the Health State Secretary of Minas Gerais, the RUTE University Hospitals from the federal universities of UFMG, UFJF, UFU, UFTM and the state university of Montes Claros already assist more than 300 municipalities in Telecardiology. They have provided more than 170.000 diagnostics remotely by specialists, answering ca. 600 consults/day.