Network. Santa Casa Hospital. This project is partially funded under the 7th Framework Programme by the European Commission.

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1 MEDNET: Latin America Health Care Network Bruno Hochhegger, MD, MsC, PhD Santa Casa Hospital Porto Alegre, Brasil This project is partially funded under the 7th Framework Programme by the European Commission.

2 1 - Introduction Access to medical care is very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Latin America. Citizens have no access to health care. They have to travel hundred of kilometres to receive a medical diagnosis. MEDNET project gave the opportunity in several sites in Brazil and Peru to have access via telemedicine to appropriate health care.

3 2 - AIMS Develop a network of healthcare in Brazil and Peru to provide, at a distance, adequate health care in underserved areas. To improve the primary healthcare by the use of telematic ultrasound systems to connect expert's know- how in large cities to rural areas.

4 3a Remote Sites The remote sites in Peru are: Mazamari Chongos Alto Pangoa Rio Negro Comas Puerto Ocopa Pariahuanca The referral hospital in Peru is: Huancayo

5 The remote sites in Brazil are: Carolina (Maranhao) Fortaleza dos Noqueiras (Maranhao) Balsas (Maranhao) Alegrete (RGdS) Pelotas (RGdS) Langoa dos Tres Cantos (RGdS) The referral ee hospital in Brazil is: Santa Casa (Porto Alegre) In Brazil the sites in Maranhao state are connected via satellite with the referral hospital and in Rio Grande do Sul via ADSL. 3b Remote Sites

6 4a System Architecture MEDNET system architecture and major components: Teleconsult application Its a 2D/3D Dicom viewer and provides a wide spread of possibilities to enrich a given image material with additional information and to send it as a message. Jabber communicator Jabber is an open source, XML based protocol for Instant Messaging and online presence. Amerhis system First DVB-RCS system with on-board processing

7 4b System Architecture

8 5 - Communication Online and offline communication On-line & off-line data transfer. Audio message available. Any type of telecommunication channel.

9 6 Teleconsultation eco o Workflow o External Physician: examines the Patient External Physician: Decision for Second Opinion Creating an offline message, including all necessary information (images, annotations, ti audio, text) t) Competence centre Expert: Replies message with possible new annotations, ti etc. If necessary: Final Online-Consultation between Physician and Expert or video conference / VoIP

10 7a Results in Brazil Over 350 teleconsultations have been done, from December 2009 to March Mainly from L3C, Pelotas, Balsas and Carolina. Mainly obstetric or abdomen exams. The use of MEDNet system gave the opportunity to avoid the transportation of 22 patients from Lagoa dos Três Cantos to the reference hospital in Porto Alegre.

11 7b Case 1 City: Carolina, MA Date: 26/02/2010 Sent by Dr. Idalci Pacient: female Reading: Came for unknown chronic pelvic pain with a diagnosis of an ovarian tumor established by a previous examination in another clinic. Dr. Idalci disagreed and asked the reference hospital for a second opinion. The second opinion corroborated with diagnosis of an ectopic pelvic kidney on the right pelvis instead of an ovarian tumor.

12 7c Case 2 City: Carolina, MA Date: 26/02/2010 Sent by Dr. Idalci Pacient: female Reading: 24 weeks pregnant, with a previous exam showing bigger head diameter of the fetus. The second opinion was very useful to confirm and to establish the diagnosis of hydrocefalus and specially to recomend urgent intra-uterous treatment in an fetal reference health center

13 8a - Conclusions Second opinion is very helpfull to the non expert doctors and their patients t in the rural areas. There is definately the need of telemedicine in these rural areas. In the most of the remote areas, this is still an expensive method that requires governments support. This kind of support will offer sustainability to similar telemedicine projects.

14 8b - Conclusions A small testimony of Dr. Marcus Dalsasso from the rural site Langoa dos Tres Cantos about his experience with MEDNet is presented below: some answers sent by the specialists were very useful for me many patients here won in the lottery, they got their diagnosis, they were operated, now they are working this has no price.

15 For more information, visit the project website:

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18 Thank you for your attention!

19 For more information, visit the project website: