Antonio Higor Freire de Morais

Introdução: A Telessaúde enquanto instrumento de cooperações técnicas pode ser utilizada para melhoria dos serviços de saúde, a exemplo do que ocorre no Rio Grande do Norte. Objetivo: Relatar experiências em cooperações técnicas do Núcleo Técnico-científico de Telessaúde do Rio Grande do Norte e sua atuação no âmbito estadual e nacional. Métodos: Foi realizado levantamento dos resultados na base de dados do Núcleo, produções acadêmicas e contextos históricos no qual esteve inserido. Para apresentação dos resultados os dados foram categorizados em: telerregulação, teleconsultas, telediagnósticos e atuação nacional. Resultados: Com o RegulaRN foram realizados mais de 140.000 telerregulações. Foram realizadas teleconsultas em pediatria (n>20.000), audiologia (n>1.500), psicologia (n>400) e multiprofissionais na Esclerose Lateral Amiotrófica (n>1.000). Foi possível realizar mais de 3.000 telediagnósticos em audiologia, densitometria óssea e espirometria. Nacionalmente, o Núcleo desenvolveu o Sistema de Monitoramento e Avaliação dos Resultados do Telessaúde integrando os dados de produção dos núcleos de telessaúde otimizando a gestão da política nacional em Telessaúde. A Plataforma Nacional de Telediagnóstico ampliou a cobertura nacional de diagnósticos e viabilizou a regulação da fila nacional. Conclusão: O Núcleo tem contribuído para a transformação digital em saúde no Rio Grande do Norte e a evolução da Telessaúde em âmbito nacional.

(1) Background: With the increasing digitalization of healthcare systems, data security and privacy have become crucial issues. In parallel, blockchain technology has gradually proven to be an innovative solution to address this challenge, as its ability to provide an immutable and secure record of transactions offers significant promise for healthcare information management. This systematic review aims to explore the applications of blockchain in health information systems, highlighting its advantages and challenges. (2) Methods: The publications chosen to compose this review were collected from six databases, resulting in the initial identification of 4864 studies. Of these, 73 were selected for in-depth analysis. (3) Results: The main results show that blockchain has been used mainly in electronic health records (63%). Furthermore, it was used in the Internet of Medical Things (8.2%) and for data sharing during the COVID-19 pandemic (6.8%). As advantages, greater security, privacy, and data integrity were identified, while the challenges point to the need for standardization and regulatory issues. (4) Conclusions: Despite the difficulties encountered, blockchain has significant potential to improve healthcare data management. However, more research and continued collaboration between those involved are needed to maximize its benefits.

Healthcare services and organizations rely on Electronic Health Records (EHRs) to manage, store, and transmit patient data records. Consequently, EHRs play a crucial role in providing high-quality services and maintaining the privacy and security of patients’ sensitive data. However, designing such complex systems with security and privacy concerns is anything but simple. This study aims to propose a Software Reference Architecture (SRA) tailored for Electronic Health Records (EHRs) with security and privacy considerations, intending to enhance the development of these systems. To achieve this goal, we analyze the classification of Reference Architectures (RAs), taking into account the primary security and privacy requirements of EHRs along with well-established architectural design methods. We propose a layered architecture for SRA with privacy and security considerations. Subsequently, we derive the following five architecture views for SRA: the feature diagram, the context diagram, the decomposition view, the layered view, and the deployment view. Each view showcases the SRA software architecture from a different perspective. Moreover, we conducted an evaluation of the proposed SRA through its application in a case study. Specifically, we applied the proposed SRA and derived the application architecture from a study focused on Brazilian EHRs. Our analysis highlights the potential issues arising from the absence of an SRA tailored for EHRs, particularly regarding privacy and security concerns surrounding patient data. Through this case study, we demonstrate the practical applicability of our proposed SRA in enhancing EHR systems.

Syphilis is an infectious disease that can be diagnosed and treated cheaply. Despite being a curable condition, the syphilis rate is increasing worldwide. In this sense, computational methods can analyze data and assist managers in formulating new public policies for preventing and controlling sexually transmitted infections (STIs). Computational techniques can integrate knowledge from experiences and, through an inference mechanism, apply conditions to a database that seeks to explain data behavior. This systematic review analyzed studies that use computational methods to establish or improve syphilis-related aspects. Our review shows the usefulness of computational tools to promote the overall understanding of syphilis, a global problem, to guide public policy and practice, to target better public health interventions such as surveillance and prevention, health service delivery, and the optimal use of diagnostic tools. The review was conducted according to PRISMA 2020 Statement and used several quality criteria to include studies. The publications chosen to compose this review were gathered from Science Direct, Web of Science, Springer, Scopus, ACM Digital Library, and PubMed databases. Then, studies published between 2015 and 2022 were selected. The review identified 1,991 studies. After applying inclusion, exclusion, and study quality assessment criteria, 26 primary studies were included in the final analysis. The results show different computational approaches, including countless Machine Learning algorithmic models, and three sub-areas of application in the context of syphilis: surveillance (61.54%), diagnosis (34.62%), and health policy evaluation (3.85%). These computational approaches are promising and capable of being tools to support syphilis control and surveillance actions.

Amyotrophic Lateral Sclerosis is a disease that compromises the motor system and the functional abilities of the person in an irreversible way, causing the progressive loss of the ability to communicate. Tools based on Augmentative and Alternative Communication are essential for promoting autonomy and improving communication, life quality, and survival. This Systematic Literature Review aimed to provide evidence on eye-image-based Human–Computer Interaction approaches for the Augmentative and Alternative Communication of people with Amyotrophic Lateral Sclerosis. The Systematic Literature Review was conducted and guided following a protocol consisting of search questions, inclusion and exclusion criteria, and quality assessment, to select primary studies published between 2010 and 2021 in six repositories: Science Direct, Web of Science, Springer, IEEE Xplore, ACM Digital Library, and PubMed. After the screening, 25 primary studies were evaluated. These studies showcased four low-cost, non-invasive Human–Computer Interaction strategies employed for Augmentative and Alternative Communication in people with Amyotrophic Lateral Sclerosis. The strategies included Eye-Gaze, which featured in 36% of the studies; Eye-Blink and Eye-Tracking, each accounting for 28% of the approaches; and the Hybrid strategy, employed in 8% of the studies. For these approaches, several computational techniques were identified. For a better understanding, a workflow containing the development phases and the respective methods used by each strategy was generated. The results indicate the possibility and feasibility of developing Human–Computer Interaction resources based on eye images for Augmentative and Alternative Communication in a control group. The absence of experimental testing in people with Amyotrophic Lateral Sclerosis reiterates the challenges related to the scalability, efficiency, and usability of these technologies for people with the disease. Although challenges still exist, the findings represent important advances in the fields of health sciences and technology, promoting a promising future with possibilities for better life quality.

Main: Electronic health record (EHR) applications are digital versions of paper-based patient health information. Traditionally, medical records are made on paper. However, nowadays, advances in information and communication technology have made it possible to change medical records from paper to EHR. Therefore, preserving user data privacy is extremely important in healthcare environments. The main challenges are providing ways to make EHR systems increasingly capable of ensuring data privacy and at the same time not compromising the performance and interoperability of these systems. Subject and methods: This systematic mapping study intends to investigate the current research on security and privacy requirements in EHR systems and identify potential research gaps in the literature. The main challenges are providing ways to make EHR systems increasingly capable of ensuring data privacy, and at the same time, not compromising the performance and interoperability of these systems. Our research was carried out in the Scopus database, the largest database of abstracts and citations in the literature with peer review. Results: We have collected 848 articles related to the area. After disambiguation and filtering, we selected 30 articles for analysis. The result of such an analysis provides a comprehensive view of current research. Conclusions: We can highlight some relevant research possibilities. First, we noticed a growing interest in privacy in EHR research in the last 6 years. Second, blockchain has been used in many EHR systems as a solution to achieve data privacy. However, it is a challenge to maintain traceability by recording metadata that can be mapped to private data of the users applying a particular mapping function that can be hosted outside the blockchain. Finally, the lack of a systematic approach between EHR solutions and existing laws or policies leads to better strategies for developing a certification process for EHR systems.

Purpose: Primary Health Care (PHC) is the coordinator of health care in Brazil and needs to be strengthened in the diagnostic field to increase health care quality. Aiming to improve the diagnostic tools currently available in PHC, this work describes the process of development and validation of two point-of-care biomedical devices for screening patients with syphilis or different kinds of cancer. Methods: The development of these devices followed nine stages of action based on the requirements established by the Ministry of Health. During development, both systems followed the stages of circuit planning, software simulation to verify the components used, cost assessment for the acquisition of features, simulation in contact matrix, development of the embedded system, and planning of the printed circuit board and storage box. Results: Both devices underwent preliminary functionality tests to assess their quality. The performance tests applied on the device to diagnose syphilis performed 8,733,194 requests, with a flow of 2426 requests/second, reaching the desired parameters of robustness, integrity, durability, and stability. In addition, functioning tests on the cancer-screening device indicated the ability to detect standard fluorescence in a minimal (150 uL) sample volume. Conclusions: Together, the methodology used for developing the devices resulted in promising equipment to improve the diagnosis and meet the requirements for executing technologies for testing and triaging patients in PHC.

RESUMO Objetivo identificar o perfil das teleconsultorias assíncronas na área da saúde auditiva do Núcleo Técnico Científico de Telessaúde do Rio Grande do Norte (RN). Métodos este estudo é retrospectivo e descritivo. Foram analisados os registros das teleconsultorias de janeiro de 2015 a dezembro de 2019 na plataforma de teleconsultoria do Núcleo de Telessaúde do RN. As teleconsultorias foram filtradas e categorizadas por dois fonoaudiólogos quanto a estado de origem, gênero e profissão do solicitante, tema e objetivo da questão. Resultados entre as teleconsultorias realizadas no período, foram incluídas, neste estudo, as teleconsultorias na área da saúde auditiva. Em ordem decrescente de frequência, os profissionais solicitantes foram: agentes comunitários de saúde, fonoaudiólogos, agentes de combate a endemias, médicos, enfermeiros, agentes de saúde pública, técnicos e auxiliares de enfermagem e outros. Quanto aos objetivos das teleconsultorias, de maior a menor frequência, foram constatadas perguntas sobre condutas, avaliação, tratamento, relações entre fatores, etiologias, prevenção, sintomas, implantação, acesso ao sistema de saúde e outras. Em relação às temáticas, em ordem descendente, foram observadas perguntas sobre hipoacusia, dispositivos auxiliares de audição, zumbido, otite, programa saúde na escola, emissões otoacústicas, otalgia, labirintite e perfuração timpânica. Conclusão as teleconsultorias assíncronas sobre saúde auditiva tiveram maior frequência por solicitantes do gênero feminino, agentes comunitários de saúde e fonoaudiólogos, sobre a temática da hipoacusia e de dispositivos auxiliares de audição, com objetivo de tomada de decisões para condutas e avaliação na área da saúde auditiva.