Barros LPdR, Carvalho ACdC, Barros Junior EdM. Questionamento sobre o custo-benefício do serviço de telecardiologia no estado de Minas Gerais. Arquivos Brasileiros de Cardiologia. 2012;99:865-6
Response letter
We thank your ‘letter to the edito’ regarding our article Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas telecardio project, and would like to clarify the three issues raised about the project.
The first considers the costs related to the medical services for writing ECG reports. The cost of the cardiologists acting in the reference centers at the five universities was categorized as third party services, included in Maintenance Expenses. The professionals were paid per shift, according to the wage policy of the Hospital das Clínicas of the Universidade Federal de Minas Gerais.
Regarding whether an ECG report would be written for every emergency and routine ECG, a fact that might influence costs, we inform that all ECGs were analyzed and a report was written, although the flows of routine and emergency cases differ1. In emergency situations, the ECG is performed immediately at the municipality, transmitted to the Telediagnosis Center, preferentially analyzed by the cardiologists on duty, and returned promptly to the municipality in-need, usually within less than ten minutes. The reports on routine ECGs follow a first-in first-out policy, all being analyzed and their reports returned to their respective municipalities on the same day, respected our working hours.
Last but not least, the possibility of creating a single center for ECG report instead of its distribution in the five universities has not been considered to reduce costs, because it contradicts the network concept proposed in the program. One of the pillars of the Minas Telecardio project was the creation of a telecardiology service network, strengthening and consolidating the university hospitals, which are reference centers in each region of the state. From the economic viewpoint, centralization would not cause a significant reduction in costs, because the coordinating center centralizes the technological infrastructure, and, because the clinical care is totally virtual, the geographical location of the cardiologist does not matter. Decentralization does not imply an increase in the number of physicians (an important cost item), because the service offered is not region-specific, the physician on duty responds to any municipality in-need. The exams are received in a centralized way at the coordinating center, and the information technology system distributes the exams between the physicians on duty. With the development of the program and its expansion to more than 600 municipalities in 2010, a quality control system was instituted, based on systematic auditing of ECG reports, to guarantee uniform and accurate analyses2.
Sincerely,
Antônio Luiz Pinho Ribeiro
