Glaucio Aranha
The coronavirus pandemic forced rapid changes in the health system. One of them was the regulation of telehealth care by Brazil’s Federal Council of Medicine (CFM), which took the integration of technology into health and health education to a new level. The link between telehealth regulation and health education brought a series of consequences: new topics and objects of study, the need to rethink health curricula to integrate the technological aspects of contemporary communication, and the role of continuing education, among others.
The main regulatory milestones that shaped the practice of telemedicine in Brazil, and its importance for public health and technology, date back to the 1990s.
The first productive discussions on regulating telemedicine in Brazil began with private initiatives. However, it was only in the 2000s that public sector involvement significantly boosted telehealth. The early proliferation of terms in the regulatory process (telemedicine, telehealth, telecare, teleconsultation and so on) already signals some difficulty in reaching consensus, which only began to emerge later, with greater precision about the scope and competences of each term.
The integration of teleconsulting, telediagnosis and tele-education, especially from the 2000s onward, not only made health care easier to access in remote regions but also created, and is still creating, the need for a continuous learning environment for health professionals.
Notable projects such as the “Estação Digital Médica Telemedicine Project”, launched in 2005, and free teleconsulting for physicians contributed to the expansion of telehealth care, integrating tele-education and telediagnosis1. However, it was without a doubt the Covid-19 pandemic, in 2020, that most accelerated regulation. The pandemic acted as a catalyst for the rapid adoption of telemedicine in Brazil and worldwide, since the need for social distancing highlighted the importance of remote access to health services, not only as a clinical tool but also as a vital educational resource for both professionals and the general public. Thus, in 2020, in response to the emergency, the CFM regulated the use of teleconsultation.
Emergency teleconsultation and its subsequent permanent regulation broadened the scope of health education. This transformation triggered a reconfiguration of the health education model: on the one hand, health professionals had to adapt quickly to the nuances of telemedicine, engaging in continuous learning about emerging technologies, digital ethics and effective remote communication. On the other, patients were brought into an interactive learning environment in which they can become better informed and manage their health, benefiting from easier access to specialists and reliable real-time information. Teleconsultation thus expanded the reach of medical care and redefined how health education is designed, delivered and received, opening new paths that are still being explored.
As the pandemic progressed, CFM Resolution 2.314/2022, published in May 2022, was discussed and approved, marking a decisive milestone in the regulation of telemedicine in Brazil. The resolution defined telemedicine as a practice mediated by digital and communication technologies, covering care, education, research and health promotion. It established the first clear guidelines for the practice, including medical autonomy, oversight by the Regional Councils of Medicine (CRM) and strict criteria for information security and data confidentiality, in line with Brazil’s General Data Protection Law (LGPD, Law 13.709/2018).
In health education, Resolution 2.314/2022 established the paradigm of health education in a digital environment. By setting clear guidelines for remote medical practice, it drives the need to educate health professionals about the ethical, legal and technical aspects of telehealth care. In addition, by emphasizing information security and data confidentiality under the LGPD, the resolution highlights the importance of educating patients and professionals about rights and responsibilities in handling health information.
In December 2022, the Telehealth Law (Law 14.510/2022) was enacted by the Federal Government, extending the practice beyond medicine. This law was an innovative and comprehensive advance for public health, broadening telemedicine beyond the traditional boundaries of health professionals’ work. This pioneering legislation recognizes and legitimizes a diverse range of digital health services, embracing fields such as psychology, physiotherapy, nutrition and other allied health specialties. In doing so, the Telehealth Law democratized access to quality health care and encouraged interdisciplinarity, valuing remote collaboration between different health professionals and fostering more holistic and integrated patient care.
In addition, Law 14.510/2022 sparked an educational revolution in health, opening up new digital competences for professionals and students in many health fields. It broadens the horizon of their skills in teleconsultation, online health management and more. In this sense, the Telehealth Law represented a paradigm shift in how health services are delivered and how health knowledge is shared and practised.
The path of telemedicine in Brazil thus reflects an ongoing challenge in integrating technology into health. Current regulation, in particular CFM Resolution 2.314/2022, shows a continued effort to balance technological innovation with the ethical and legal principles of medicine, ensuring effective and safe telehealth practice.
The regulatory milestones of telehealth care in Brazil have a history of evolution and adaptation to the needs of the health system and the population, reflecting how the Brazilian health system has adapted to emerging technologies and to changing public health needs. Beyond technological advances in service delivery, they mark a new era in health education. Navigating this new digital territory requires a renewed educational approach, covering both training health professionals for telehealth practice and educating patients on how to manage and take an active part in their health in a digital environment. This new paradigm of health education, linked to telemedicine, offers a promising path to better quality of care and a society that is better informed about health.
On the one hand, we cannot be naive and ignore that telehealth care is also driven by the wish to relieve overcrowded hospitals and to reach patients for economic reasons. On the other, it cannot be denied that this new model offers opportunities for health care to reach geographical areas often lacking specific health professionals. Telehealth care poses challenges, especially regarding professionals’ adaptation to this new modality and concerns about the effectiveness and safety of remote care.
To support this modality of care, the CFM authorized three main tools: tele-orientation, telemonitoring and tele-interconsultation. These tools allow physicians, respectively, to provide guidance, monitor patients’ health and exchange information with other professionals.
The use of these tools is governed by specific guidelines on issuing prescriptions and medical certificates remotely, as well as on payment and the limits of remote care. It is essential that physicians clearly communicate the limitations of remote consultations, especially in specialties that require a physical examination for diagnosis.
One of the great benefits of telehealth care is that it offers an alternative for triage, helping to determine whether an in-person assessment is needed. All medical specialties are authorized to hold online consultations, although some are more limited than others because diagnosis requires physical contact.
In this context, telemedicine is seen as an evolving field that offers significant opportunities for the future of medical practice, especially in public health crises such as the coronavirus pandemic and in communities that are hard to reach for geographical reasons and can benefit from remote care.
Suggested reading:
Celes, R.S., Rossi, T.R.A., Barros, S.G., Santos, C.M.L., Cardoso, C. A telessaúde como estratégia de resposta do Estado: revisão sistemática. Revista Panamericana de Salud Pública [online]. 2018, v. 42 [Accessed 19 November 2023], e84. Available at: <https://doi.org/10.26633/RPSP.2018.84>. Epub 16 Aug 2018. ISSN 1680-5348.
Lisboa, K. O., Hajjar, A. C., Sarmento, I. P., Sarmento, R. P., & Gonçalves, S. H. R.. (2023). A história da telemedicina no Brasil: desafios e vantagens. Saúde e Sociedade, 32(1), e210170pt. https://doi.org/10.1590/S0104-12902022210170pt
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