Do Public EHRs and Telehealth Improve Primary Care? Evidence from Brazil
1
International Health, Johns Hopkins University, Baltimore, MD, United States
Popul. Med. 2026;8(Supplement Supplement 1):A943
ABSTRACT
BACKGROUND:
Electronic health records (EHRs) and telemedicine are digital health technologies that aim to improve data quality, service capacity, and health access.¹⁰–¹⁶ In Brazil, they are the main digital interventions in primary health care (PHC), with effects driven by decades-long public policies, but understudied.¹⁹–²¹
METHODS:
Mixed-methods study to characterize reach, effectiveness, and scale-up of the EHR and telehealth public initiatives in Brazil. Descriptive statistics (2017–2023 data) to trace telehealth use, avoidable referral rates, and coding practices; multiple regression analyses identified enablers of EHR, and a quasi-experimental Difference-in-Differences assessed changes in PHC visits associated with EHR. Forty interviews with developers and implementers were coded using the RE-AIM framework.
RESULTS:
Municipalities adopting the government-EHR tended to have lower income and more rural residents. They showed a 73-per-1,000 visit increase (24%) and a 13% antenatal care rise; differences to private EHRs are not statistically significant. EHRs expanded the range of reported health conditions beyond those prefilled in paper systems. Between 2017 and 2023, telediagnosis utilization increased by 57% (451K), with stable coverage (1.3K municipalities). Telediagnosis reached small, rural municipalities (55% rate increase in 1-20K inhabitants; 14% in over 500K; 52% increase in rural ones), while provider teleconsultation declined 70%, and shifted toward larger, urban areas, with varying effectiveness (avoiding referrals, 56-70%). Teleconsultations with clients peaked in 2021 (201K), with demand for respiratory (34.2%) and mental health (3.5%) issues. Telehealth and government EHR were developed by public-academic partnerships, through bottom-up and top-down approaches. Telediagnosis became the priority telehealth service.
CONCLUSIONS:
Government-provided digital technologies are advancing service delivery in Brazil. EHR adoption significantly improved healthcare productivity and data reporting quality in PHC facilities, and telediagnosis expanded equitably, supported by MoH incentives. Public-led DH initiatives enhance access to health services in a country of continental dimensions with social inequality and varying state capacities.
Electronic health records (EHRs) and telemedicine are digital health technologies that aim to improve data quality, service capacity, and health access.¹⁰–¹⁶ In Brazil, they are the main digital interventions in primary health care (PHC), with effects driven by decades-long public policies, but understudied.¹⁹–²¹
METHODS:
Mixed-methods study to characterize reach, effectiveness, and scale-up of the EHR and telehealth public initiatives in Brazil. Descriptive statistics (2017–2023 data) to trace telehealth use, avoidable referral rates, and coding practices; multiple regression analyses identified enablers of EHR, and a quasi-experimental Difference-in-Differences assessed changes in PHC visits associated with EHR. Forty interviews with developers and implementers were coded using the RE-AIM framework.
RESULTS:
Municipalities adopting the government-EHR tended to have lower income and more rural residents. They showed a 73-per-1,000 visit increase (24%) and a 13% antenatal care rise; differences to private EHRs are not statistically significant. EHRs expanded the range of reported health conditions beyond those prefilled in paper systems. Between 2017 and 2023, telediagnosis utilization increased by 57% (451K), with stable coverage (1.3K municipalities). Telediagnosis reached small, rural municipalities (55% rate increase in 1-20K inhabitants; 14% in over 500K; 52% increase in rural ones), while provider teleconsultation declined 70%, and shifted toward larger, urban areas, with varying effectiveness (avoiding referrals, 56-70%). Teleconsultations with clients peaked in 2021 (201K), with demand for respiratory (34.2%) and mental health (3.5%) issues. Telehealth and government EHR were developed by public-academic partnerships, through bottom-up and top-down approaches. Telediagnosis became the priority telehealth service.
CONCLUSIONS:
Government-provided digital technologies are advancing service delivery in Brazil. EHR adoption significantly improved healthcare productivity and data reporting quality in PHC facilities, and telediagnosis expanded equitably, supported by MoH incentives. Public-led DH initiatives enhance access to health services in a country of continental dimensions with social inequality and varying state capacities.
| eISSN: | 2654-1459 |
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