A comparison of telehealth programs between the USA and Brazil: a legal perspective

Figures & data

Table 1 Timeline of major telehealth legislation

1991-2000	2001-2009	2010-2014
1991: Georgia: First pilot 1992: Georgia: First public network from telecom for TM 1995: California: Grass-Roots Committee TM Planning 1996: California: SB 1665 1996: Arizona: SB 144 1996: HIPAA Act	Grass-Roots Program: 2006: K-University Public Education Facilities Bond Act 2008: California AB 2120 2009: ARRA-American Recovery and Reinvestment Act • Health Information Technology for Economic and Clinical Health Act (HITECH)	2011: California Health Care Foundation to be compliant with ACA 2011: AB415 – Telehealth Advancement Act 2012: Affordable Care Act (ACA) Ratification 2012: Food and Drug Administration Safety Innovation Act (FDASIA) 2013: CMS Innovation Center
1999: WMA: Declaration of Tel Aviv	2006: Project among the USA, India, and UM for Telemedicine in Afganistan	2009/2010: WHO: two reports with opportunities of development in telemedicine
1997: Parecer n° 31/97: Petrobras consults CFM about offshore patients	2001: Medical Act (CFM n° 1627/2001) 2002: Parecer CFM n° 36/2002: Telecare 2002: CFM n° 1.638 e 1.639/2002 2002: CFM n° 1.643 Telemedicine 2007: National Telehealth Program (Portaria MS/GM n° 2.546) 2009: Teleradiology (CFM n° 1.890)	2010: Medical Ethical code 2013: Medical Act Amendment

Abbreviations: WMA, World Medical Association; WHO, World Health Organization; UM, University of Miami; TM, telemedicine; HIPAA, Health Insurance Portability and Accountability Act; CFM, Conselho Federal de Medicina.

Table 2 USA/Brazil comparative telehealth regulation

	1991-2000	2001-2009	2010-2014
First pilot
Business case
Infrastructure provider law
Telemedicine regulation for education
General application
Security and privace technical protocol
National Public Policy
Public reimbursement for emergency
Private reimbursement for appointment and treatment
Public funding for emergency
Public funding for emergency appointment and treatment
Devices regulation

Abbreviation: WMA, World Medical Association.

Table 3 Key differences between telehealth legislation from the USA and Brazil

	USA	Brazil
Key issues
Categories permited by law
Permitted relationship
Medical civil responsibility
Consent
Devices rules
Multidisciplinary team
Diagnostics
Drugs prescription