BACKGROUND:
Telehealth expansion in low- and middle-income countries faces persistent technical, organizational, and regulatory challenges (1). In Brazil’s Unified Health System (SUS), fragmented information systems, infrastructure limitations, and workforce constraints hinder the sustainable integration of digital health into routine care. This study presents the experience of a university-based Digital Health Hub in addressing these barriers through coordinated technological and institutional strategies (2-3). To analyze systemic challenges to telehealth implementation in public health services and to describe the strategies planned for adoption by a Digital Health Hub to promote sustainable and scalable solutions within the SUS.

METHODS:
Qualitative, descriptive implementation study conducted in 2025, the first year of activities. Data were collected through document analysis, technical reports, system logs, and meeting records. Thematic analysis identified barriers and enabling factors related to telehealth deployment.

RESULTS:
Key challenges included limited interoperability, constrained connectivity, insufficient digital literacy among health professionals, fragmented governance structures, and regulatory uncertainties. Integration with Brazil’s Primary Care Information System (e-SUS APS) was especially challenging: teleconsultation tools often failed to interface with local electronic medical records, forcing parallel data entry and reducing adherence to digital workflows. The Digital Health Hub planned response includes developing an integrated teleconsultation platform, implementing standards-based interoperability layers and data pipelines to enable structured exchange with e-SUS APS; providing continuous professional training; and establishing governance mechanisms to improve coverage, stability, and user experience.

CONCLUSIONS:
The Digital Health Hub model implemented by UNIFESP highlights the role of academia in adapting global technological solutions to local realities. This university-based approach has proven effective in overcoming systemic barriers in the SUS, establishing a replicable framework for other Brazilian states and low- and middle-income countries. By aligning technological development with professional training and institutional governance, UNIFESP ensures that digital health innovation is effectively translated and sustained in resource-limited public health settings.