ABC | Volume 113, Nº3, September 2019

Viewpoint Lopes et al Digital health, universal right, duty of the State? Arq Bras Cardiol. 2019; 113(3):429-434 is a complex task. It will be a challenge, to be overcome, to bring health professionals – notably specialists – to the most distant corners of the country. 4 On the other hand, there is a constant tension between the medical class and health authorities about the possible alternatives for the supply of doctors to society. This theme took on an epic battle line on the occasion of the sanction of Law 12.871, dated October 22, 2013, 5 which instituted the “ Programa Mais Médicos ” (More Doctors Program) in Brazil. The offer of doctors in the country, since the institution of this Program, has increased, mainly due to the increase in the number of medical schools opened in the country. However, the proportion of doctors per 100,000 inhabitants is still below the average of the countries in the Organization for Economic Cooperation and Development (OECD). It should be added that the distribution of these physicians is heterogeneous, aggravating this scenario. 6 In this sense, the use of information and communication technologies, through a Telemedicine network, could contribute to the universality and integrality of the health system, in line with the constitutional decree. Telemedicine as a tool to expand universal access to health The remarkable advancement of information and communication technologies and their application in medicine have enabled a secure transmission of data, facilitating the interaction of health professionals, opening a door for the democratization of access to medical knowledge, and strengthening collaboration among the various levels of healthcare. Telemedicine can be conceptualized as an organized and efficient way of practicing distance medicine for the purposes of informing, diagnosing and treating individuals, alone or in groups, based on data, documents or other reliable information transmitted by means of telecommunications. Currently, the use of telemedicine has been increasing, ranging from consultations (teleconsultation), diagnosis (telediagnosis) to complex robotic surgeries (tele-surgery). All these advancements, which project the broader concept of digital health, must take place preserving the millennial postulates of medical art, always focused on the patient’s best interests. 7 Digital health interventions are not a substitute for the health systems already in place, as there are still significant limitations to what digital health is capable of addressing. However, the judicious use of this technology can contribute to improvements in health care, as long as it is based on the evaluation of its benefits, damages, acceptability and viability. 7 When approaching the intricate subject of health- guaranteeing regulations, as a fundamental right, and of the application of information and communication technologies to promote the practice of distance medicine, the basis of Telemedicine, there is the need to defend the preservation of the patients' privacy. The inviolability of private life, such as the right to health, is also an inseparable part of the concept of the dignity of the human person. 1 Therefore, security in data transmission is imperative for the implementation of any Telemedicine program. The millennial principle of medical secrecy, valid since Hippocrates, is also a constitutional imposition. The legal framework applicable to Telemedicine in Brazil is comprehensive, involving from the sanitary legislation to the recent internet regulatory framework to ensure its regular practice. Currently, international protocols ensure the secure transmission of data: the Health Insurance Portability and Accountability Act (HIPPA) 7 contains a set of standards that ensure the security of the data transported and of those responsible for its transmission. Regulation of Telemedicine by the Brazilian Federal Council of Medicine The Brazilian Federal Council of Medicine (CFM), an autarchic body established by Law 3.268, dated September 30, 1957, 8 is responsible for supervising professional ethics throughout the Republic and, at the same time, judging and disciplining the medical profession through supervisory and regulatory action. With a focus on these attributions, CFM is responsible for regulating the participation of doctors in activities related to the employment of Telemedicine throughout the country’s territory. Law 12.842, 9 dated July 10, 2013, the Medical Act, which provides for the practice of medicine, ratifies that the new medical procedures and therapies for regular use in Brazil must necessarily be evaluated by the Brazilian Federal Medical Council regarding safety, efficiency, convenience, and benefits to the patient. Telemedicine, with a myriad of employment possibilities in prevention, diagnosis, treatment and rehabilitation, as well as in health promotion, undoubtedly falls within and can be validated by CFM. Because of its innovative character, it brings a bioethical conflict potential, which imposes a zetetic – investigative – analysis of its principles, due to the clash between traditional ethics, which permeates the face-to-face relationship between doctors and patients, and the new frontier opened by the progress of information and communication technology. The Brazilian Federal Medical Council, through Resolution CFM 1.643/2002, 10 provided for Telemedicine, defining it “as the exercise of Medicine through the use of interactive audiovisual and data communication methodologies, with the objective of health assistance, education and research”. This regulation requires the use of appropriate technology and observance of the CFM’s technical standards regarding data storage, handling and transmission, confidentiality, privacy and guarantee of professional secrecy. The role of doctors who participate in the professional act at a distance is restricted to emergencies, or when requested by the doctor in charge of administering in-person care. In 2014, the CFM again expressed its views on the subject, through Resolution CFM 2.107/2014, 11 to discipline the use of Teleradiology. This Resolution updated the previous standard, published in 2009. The development of technology and the democratization of access to cellular telephony pluralized the development of applications dedicated to digital health. Current possibilities of employment of Telemedicine include several services, which include: (a) Teleconsulting, Teleinterconsulting , Telediagnosis, Tele‑orientation, Telemonitoring, Tele-surgery and Medical Tele-Screening. Although part of these services is not explicitly regulated by the 430