title: The Experience of a Sustainable Large Scale Brazilian Telehealth Network.
abstract: In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil.
  
  
  
  To describe the successful experience of the TNMG in 10 years of activities.
  
  
  
  The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff.
  
  
  
  Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction.
  
  
  
  The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the quality of the PHC.
authors.affiliation: 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil .|2 Medical School, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .
authors.forename: Milena
authors.initials: M
authors.lastname: Soriano Marcolino
authors.affiliation: 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil .
authors.forename: Renato
authors.initials: R
authors.lastname: Minelli Figueira
authors.affiliation: 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil .|2 Medical School, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .
authors.forename: Julia
authors.initials: J
authors.lastname: Pereira Afonso Dos Santos
authors.affiliation: 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil .|3 Universidade Federal de São João del-Rei , Divinópolis, Brazil .
authors.forename: Clareci
authors.initials: C
authors.lastname: Silva Cardoso
authors.affiliation: 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil .|2 Medical School, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .
authors.forename: Antonio
authors.initials: A
authors.lastname: Luiz Ribeiro
authors.affiliation: 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil .
authors.forename: Maria Beatriz
authors.initials: MB
authors.lastname: Alkmim
mesh_terms: D001291:Attitude of Health Personnel; D001938:Brazil; D003258:Consumer Behavior; D003362:Cost-Benefit Analysis; D005378:Financial Support; D006801:Humans; D018670:Monitoring, Ambulatory / Q000191:economics / Q000379:methods; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration; D019114:Remote Consultation / Q000191:economics / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration
keywords: primary healthcare; quality of healthcare; teleconsultation; telehealth