Accurate diagnosis

Brazil is experiencing the challenge of shortening the distance between the islands of excellence in the health industry, which enjoy the benefits of digital transformation, and a great part of the sector, which still lives in the paper era.

By Andrea Vialli

January-March | 2017

Digital technologies are transforming the health world and promise, for the next few years, a revolution in the way that the doctors relate to their patients, how the clinical information is organized and even in the way that medicines are prescribed and administered. From cell phone applications that show the right time to take medication, through the use of analytics in the interpretation of patients’ data, until the use of telemedicine to serve remote areas, the future of health, inside and outside of hospitals, passes through digital advances.

In Brazil, some of these trends begin to be applied in the so-called “islands of excellence”, especially in charity hospitals that invest to bring state of art innovation in the care to their patients. But the Country has to face an even greater challenge, which is to increase the efficiency of the entire sector’s chain and address the historical challenges of the public health system, in a scenario of stagnated economy and budget restrictions. Around 10% of the Brazilian Gross Domestic Product (GDP) is invested in health, but resources are far from appropriately benefiting the population, because there is a lack in efficiency and productivity. The private health also suffered a blow before the economic crisis, which has led to unemployment and to more than 2 million people lose their health plans over the past two years – today, around 49 million Brazilians have health plans.

The Federal Government is making investments in Information Technology (IT) aiming to making the Unified Health System (SUS) more efficient. In October 2016, the Ministry of Health announced the purchase of three supercomputers, at a cost of R$ 67 million, to computerize and integrate the SUS data within the electronic medical records project. The goal is to have a digital national system with information on Brazilians who use the primary care services – all consultations, diagnoses, procedures, admissions, examinations and drug prescriptions should be recorded in a single medical record in Basic Health Units (UBSs), which can be accessed from any part of the Country. To make the project advance, in addition to the investment in IT, the Ministry of Health stated that it will condition the transfer of funds to the municipalities to the sending of data to the Federal Government. Although all the cities of the Country have at least one broadband internet point, 76% of the UBSs still record the patients’ history on paper.

“The digital technology, in addition to providing an individualized and preventive care, needs to be a tool to expand the population's access to health services.”

Enrico De Vettori, Deloitte leader partner for the Life Sciences and Health Care industry

The adherence of Brazilian municipalities to electronic patient records stumbles on factors such as lack of connectivity and qualified staff to deal with the new demands. In December 2016’s balance sheet, 63% of Brazilian municipalities (2,060) had adhered to the system, but 151 cities hadn’t even signed up. Among the main reasons for the absence of the platform, the cities argued connectivity problems (74%), lack of equipment (85%) and low qualification in the medical records use (75%). “Digital technologies can minimize frauds, abuses and wastes in the public health system, but it is necessary to go beyond electronic patient records in SUS”, says Enrico De Vettori, Deloitte leader partner for the Life Sciences and Health Care industry.

Although it is an important first step, the unification of patient information in a single database in itself is not a transformation, since there are countries that have already done this for over a decade – such as the United Kingdom, for example. For De Vettori, Brazil faces extremes in the health area – there are islands of excellence, such as hospitals that bring state of art innovation to the medical-hospital area, and, at the same time, large gaps in the public system. “About 75% of the population have no health plan, have restricted access to diagnostics and arrive late to the public network”, he says.

According to De Vettori, the Country presents business opportunities for foreign investors and for Brazilian companies that decided to bet on digital services directed toward the health area. “The digital technology, in addition to providing an individualized and preventive care, needs to be a tool to expand the population’s access to health services. Brazil, however, still has a lot to advance to transform health care, both in public and private networks.”

The answer lies in the genes

The German Hospital Oswaldo Cruz, in São Paulo, is one of the centers of high complexity which has made investments in innovation to the medical area. In the past year, the hospital entered into a partnership with the Portuguese company Coimbra Genomics to bring to Brazil the Elsie software platform, which performs the genomic analysis of the patient to advise the physician in relation to diagnosis and treatment. This is a first step toward the implementation of the personalized genomic medicine, one of the main trends of the application of digital technologies in the medical field. From a patient’s blood sample, it is possible to carry out the sequencing of the DNA of the person, and the Elsie software takes care of translating the information on the genetic code to the medical specialist, without requiring the presence of a geneticist to support the interpretation of the data. From there, it is possible to make decisions in relation to the best treatment for each patient.

“In the next ten years, the genomic analysis will become an increasingly used tool for making medical decisions. The technology will not replace laboratory and imaging tests, but will be a crucial element in the choice of treatments”, explains Jefferson Fernandes, Superintendent of Education and Science of the German Hospital Oswaldo Cruz. According to him, the main applications of personalized genomic medicine have been in the areas of oncology and neurology – the DNA analysis may indicate the propensity of a person to develop Alzheimer’s disease, for example – and there is also a promising field for cardiology, gastroenterology and ophthalmology.

The technology is still under testing by the hospital, and the expectation is that it will begin to be offered commercially in June 2017. In addition to Brazil, the Elsie platform is being tested by hospitals in Portugal, Israel, Estonia and Finland and has already entered into commercial phase in Germany. The cost in Brazil is not yet defined, but Fernandes points out that the price of genetic sequencing is on a downward trend and should become more accessible in the next five years. “In 2001, the cost of doing the genetic mapping of a patient was not less than US$ 10 million. Today it is possible to do it starting at US$ 1,000,” he says.

Telemedicine shortens distances

In the hospitals’ search for cutting-edge technology and excellence in care, telemedicine is another possibility that the digital world brought to shorten the distances between doctors and patients. The practice of remote medicine still faces restrictions in Brazil – it is not possible, for example, for a doctor to provide diagnosis and prescribe medicines without the live consultation with the patient –, but it is possible to make the analysis of exams, the follow-up of patients and the exchange of information through the practice, as well as training of medical staff.

Another advantage of telemedicine is bringing closer reference centers and public hospitals. At the German Hospital Oswaldo Cruz, the Telemedicine for Cerebral Vascular Accident (CVA) Project, which began in 2014, provides support to a network of public hospitals – four are of the municipal network in São Paulo and other in Guarulhos, Goiania and Recife. The technology allows specialists to remotely support patients of the public network who suffered an acute stroke. The results are positive: the death rate has dropped 20% since the project began.

It organizations are aware of the opportunities that the digital transformation can bring to health management in Brazil. Cisco, a North American IT company, bets on the supply of equipment and software for the remote medicine practice in the Country. In 2013, the company donated high definition sound and image equipment for pediatric care in the municipalities of Lagarto and Tobias Barreto, in the country side of Sergipe, in a partnership with the Federal University of Sergipe (UFS). The project connects general practitioners who perform care on those locations to hospitals of Aracaju and São Cristovão, where the campus of the University is, generating an exchange of information, support in diagnosis and a more qualified care.

“As well as the municipalities from Sergipe, Brazil has many remote places with a shortage of specialists and who can benefit from the use of telemedicine and other solutions for connected health care”, says José Paulo Oliveira, director of Public Sector at Cisco. The company is part of a working group within the Ministry of Science, Technology and Innovation (MCTI), in order to discuss the guidelines for digitization of public services in several areas, including health.

Computers that learn

“Teach” computers to think and process information, assisting physicians in the diagnosis and treatment, as well as giving support to the patients dealing with chronic diseases, such as diabetes, is what IBM promises with its Watson cognitive computing platform, first presented in 2012. Unlike the programed computing, cognitive uses artificial intelligence so that computers act as the human brain, learning to make correlations between the topics and continuously tweaking its way of “thinking”. The artificial intelligence is the big bet of the applications industry for the coming years: the IDC consulting firm estimates that the technology will be incorporated to half of the applications to be developed until 2018.

To IBM, the platform application in the health area is so strategic that the company created in 2015 a specific business division, Watson Health, with contributions of $4 billion in technology companies focused on the clinical area – Truven Health Analytics, a provider of cloud healthcare data, and Merge Healthcare, company with a large database of medical images. Globally, one of the main applications for the Watson Platform in health is focused on oncology: the system is part of an immense database, which includes clinical studies and scientific and historical data of patients to recommend treatments against various types of cancer, as well as their chances of cure.

“The Watson Platform not only brings all possible responses to a research, but also shows the scientific evidences that support its answers”, explains Eduardo Cipriani, leader of IBM Watson Health Brazil.

In Brazil, the Watson Health platform arrived in September 2016, and one of the first customers was Fleury Medicine and Health laboratory, which will use the Watson tool for Genomics for diagnostics. Hosted in the cloud, the genomics medicine technology should help doctors to identify relevant medications and trials based on the genetic profile of the patients. TheraSkin, a Brazilian pharmaceutical industry specializing in Dermatology, is another customer of the platform in the Country: it is using the technology in drug development, from a database of clinical researches. The access to qualified database is a huge time saver for the researcher: a study of articles and scientific evidences that could take up to three weeks is completed in ten minutes.

Facing the so known challenges of the health system in Brazil, the digital transformation is presented as a strong ally for the sector to earn in efficiency and quality in the resource management and, primarily, in assistance to patients.