Στην παρούσα διπλωματική εργασία, συλλέγονται ηλεκτροκαρδιογραφήματα από τα ακόλουθα εμπορικά συστήματα, που απαρτίζουν τον εξοπλισμό της εργασίας: ο 12‐κάναλος καρδιογράφος BT‐12, η ζώνη corbelt, το holter 3 και 12 απαγωγών, και ο 12‐κάναλος καρδιογράφος ELI‐10. Οι καρδιακές αρρυθμίες, ο έλεγχος ενήλικων ασθενών με βηματοδότες, η αξιολόγηση ECG που τεκμηριώνει τις θεραπευτικές επεμβάσεις σε μεμονωμένες ασθενείς ή σε ομάδες ασθενών, η μεταβλητότητα του καρδιακού ρυθμού σε συγκεκριμένο χρόνο, οι κλινικές και οι επιδημιολογικές μελέτες και έρευνες και η παρακολούθηση της καρδιακής λειτουργίας ακόμη και των νηπίων είνα ορισμένες από τις ενδείξεις που έχουν πιστοποιήσει ότι τα παραπάνω όργανα είναι κατάλληλα για χρήση! Τα καρδιογραφήματα που δίνουν αυτά τα συστήματα μπορεί να βρίσκονται με μια από τις παρακάτω μορφές: αρχείου κειμένου .txt, αρχείο .scp, αρχείο .xml, αρχείο .pdf/edf ή αρχείο dicom. Η ανάλυση όλων των μορφών των αρχείων καρδιογραφήματος και η πλήρη κατανόηση της δομής τους είναι αναγκαία για την σωστή διαχώιση των αρχείων καρδιογραφήματος ανάλογα με το χρησιμοποιούμενο πρότυπο! Ανάλογα με τον τύπο του καρδιογραφήματος, χρειάζεται και διαφορετικό προγράμμα ώστε να μπορεί να διαβάσει το αντίστοιχο καρδιογράφημα και να το απεικονίζει σε μορφή ‘φιλική’ για το γιατρό. Ο αρμόδιος γιατρός δεν ενδιαφέρεται για το ποιά μορφή έχει το αρχείο καρδιογραφήματος (εάν είναι .txt, .scp, .xml, .pdf/edf ή αρχείο dicom), απλά επιθυμεί να βλέπει μια απεικόνιση ώστε να κάνει επεξεργασία αυτής και να προβλέπει τις αρρυθμίες. Τα συστήματα που περιγράφηκαν στην εργασία αυτή, παρέχουν διαφορετικούς τύπους δεδομένων και χρησιμοποίησαν διαφορετικούς viewers για να μπορέσουν να γίνουν ορατά σε κατανοητήμορφή τα αντίστοιχα δεδομένα. Στο τελευταίο κεφάλαιο παρουσιάζονται δεδομένα προσομοίωσης φυσιολογικών εθελοντών, ασθενών στο νοσοκομείο και ασθενούς κατ’οίκον νοσηλεία. / In the present diplomatic work, are collected electrocardiograms from the following commercial systems, that compose the equipment of work: 12 ‐ chanel ECG, BT ‐ 12, the area corbelt, holter 3 and 12 kidnappings, and 12 ‐ chanel ECG, ELI ‐ 10. The cardiac arrhythmias, the control of adult patients with pacemakers, evaluation ECG that argues the therapeutic interventions in individual patients or in teams of patients, the variability of cardiac rythm in concrete time, the clinics and the epidemiologic studies and certain researches and the follow-up of cardiac operation of even infants from the clues that have certified that the upper bodies are suitable for use! The cardiograms that give these systems can they are found with one of the following forms: file of text .txt, file .scp, file .xml, file .pdf/edf or file dicom. The analysis of all forms of files of cardiogram and complete comprehension of their structure is necessary for the correct distribution of files of cardiogram depending on the used model! Depending on the type of cardiogram, it needs also different program so that it can read the corresponding cardiogram and portray him in form 'friendly' for the doctor. The responsible doctor does not interest itself for who form she has the file of cardiogram (if it is .txt, .scp, .xml, .pdf/edf or file dicom), simply she wishes she sees a depiction so that she makes treatment of this and she forecasts the arrhythmias. The systems that were described in this work, provide different presses of data and used different viewers in order to they can become visible in undertsandable format for the corresponding data. In the last capital are presented data of simulation of physiologic volunteers, patients in the hospital and ill at home hospitalisation.

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Thesis (MEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Telemedicine is a rapidly developing field in the medical sector that utilises modern day technology to provide improved health services to rural and remote areas. Telemedicine can also provide specialist support and remote consultation to facilities where there is a lack of resources. In South Africa, where a large percentage of the population live in rural and remote areas, telemedicine has the potential to alleviate the burden on national health resources, whilst improving the quality of healthcare. Various telemedicine projects have been piloted in South Africa from its inception in 1998, with the primary objective being to address the inequalities of healthcare delivery in South Africa. Most of these projects did not get past their initial pilot phase. It is often difficult to determine the factors that contribute to a telemedicine project’s success or demise, due to the unavailability of documentation for projects. The purpose of this research project is to contribute towards sustained implementation of telemedicine projects, by assisting the Medical Research Council (MRC) in their current efforts. This has been done through the development of an information management system which can record and store relevant information regarding telemedicine projects in South Africa. The system allows users to document telemedicine projects, whilst also giving them access to technical- and descriptive information. A total of 102 projects from the international academic domain were used to perform a meta-study, in order to determine the nature of telemedicine projects. Articles documenting various telemedicine projects were selected from the Journal of Telemedicine and Telecare. The telemedicine process data was then extracted and uploaded from these articles to the first version of the information system developed in this thesis. The meta-study was also used as the first phase of verification for the information system being developed. Changes were made to the information system after the meta-study was completed. These changes included alterations to the database and the interface of the information system. Additional tables were added to the database of the information system, to store the data required by the MRC, in order to document telemedicine projects in South Africa. The verification of the information system consisted of two testing phases. The first testing phase, the alpha test, was performed as part of the meta-study. The second testing phase was conducted after changes were incorporated into the information system, as necessitated by the alpha test and meta-study. In this phase of testing users could access the information system via the Internet. The information system was validated in two phases. Firstly it was shown that the information system met the objectives set out for this project. Secondly it was shown that the information system has the capacity to assist in planning, development, implementation, and research through retrospectively examining two telemedicine projects in which Dr. Sam Surka (senior scientist and clinical manager at the MRC) was involved. Outcomes of the project indicated that the information system is a useful tool for identifying similar telemedicine projects, and for assisting stakeholders in telemedicine projects. Finally the research process was reflected upon to identify future work in terms of collecting telemedicine process data, as well as the assistance of telemedicine research within the South African context / AFRIKAANSE OPSOMMING: Telemedisyne is 'n vinnig ontwikkelende veld in die mediese sektor wat gebruik maak van moderne tegnologie om verbeterde gesondheidsdienste te verskaf aan landelike en afgeleë gebiede. Telemedisyne kan ook spesialis-ondersteuning en afstandsraadgewing bied aan fasiliteite waar daar 'n gebrek aan hulpbronne is. In Suid-Afrika, waar 'n groot persentasie van die bevolking in landelike en afgeleë gebiede woon, het telemedisyne die potensiaal om die las te verlig op nasionale gesondheid hulpbronne, asook die gehalte van gesondheidsorg te verbeter. Verskeie telemedisyne projekte is in Suid-Afrika geloods vanaf 1998, met die primêre doel om die ongelykhede van gesondheidsorg in Suid-Afrika aan te spreek. Meeste van hierdie projekte het egter nie voortbestaan na hul aanvanklike proeffase nie. Dit is dikwels moeilik om die bydraende faktore te bepaal wat 'n telemedisyne projek se sukses of ondergang veroorsaak, as gevolg van die onbeskikbaarheid van dokumentasie vir die projekte. Die doel van hierdie navorsingsprojek is om ‘n bydrae te lewer tot die volhoubare implementering van telemedisyne projekte deur hulp te verleen aan die Mediese Navorsingsraad (MNR) se huidige ondernemings. Dit is gedoen deur 'n inligtingstelsel te ontwikkel wat relevante inligting opneem en stoor ten opsigte van telemedisyne projekte in Suid-Afrika. Die stelsel laat gebruikers toe om telemedisyne projekte te dokumenteer, asook toegang te bekom tot tegniese en beskrywende inligting. 'n Totaal van 102 projekte van die internasionale akademiese omgewing is gebruik om 'n meta-studie uit te voer ten einde die aard van telemedisyne projekte te bepaal. Artikels wat verskeie telemedisyne projekte dokumenteer is gekies uit die “Journal of Telemedicine and Telecare”. Die telemedisyne proses data is vanuit hierdie artikels onttrek en opgelaai na die eerste weergawe van die inligtingstelsel wat in hierdie tesis ontwikkel is. Die meta-studie is ook gebruik as die eerste fase van verifikasie vir die inligting stelsel wat ontwikkel word. Veranderinge was aangebring aan die inligtingstelsel na die meta-studie voltooi was. Hierdie veranderinge sluit in die uitbreiding van die databasis en die koppelvlak van die inligtingstelsel. Addisionele tabelle is bygevoeg tot die databasis van die inligtingstelsel om die addisionele data te stoor soos vereis deur die Mediese Navorsingsraad (MNR), ten einde die telemedisyne projekte in Suid-Afrika te dokumenteer. Die verifikasie van die inligtingstelsel bestaan uit twee toets fases. Die eerste toetsfase, die alfa toets, was uitgevoer as deel van die meta-studie. Die tweede toetsfase was uitgevoer na veranderinge aan die inligtingstelsel gemaak is, soos genoodsaak deur die alfa toets en meta-studie. In hierdie toetsfase kon gebruikers toegang tot die inligtingstelsel kry deur die Internet. Die inligtingstelsel was bekragtig in twee fases. Eerstens, dit is aangetoon dat die inligtingstelsel die doelwitte bereik het, soos uiteengesit vir hierdie projek. Tweedens was aangetoon dat die inligtingstelsel die vermoë het om te help met die beplanning, ontwikkeling, implementering, en navorsing deur twee telemedisyne projekte te ondersoek waarin Dr. Sam Surka (senior wetenskaplike en kliniese bestuurder by die MNR) betrokke was. Uitkomste van die projek het aangedui dat die inligtingstelsel 'n nuttige hulpmiddel is vir die identifisering van soortgelyke telemedisyne projekte, terwyl dit ook belanghebbendes van telemedisyne projekte ondersteun. Ten slotte was daar besin oor die navorsingsproses om toekomstige werk te identifiseer in terme van die versameling van telemedisyne proses data, asook die ondersteuning van telemedisyne navorsing binne die Suid-Afrikaanse konteks.

Introduction : La télémédecine en général et la télé échographie en particulier est une des solutions indéniables au problème de pénurie de médecins spécialistes notamment dans les pays en développement au regard des progrès sans cesse croissant des nouvelles technologies de I‘information et de la communication. Objectif : Concevoir et valider un système de télé expertise échographique temps réel et de télédiagnostic échographique temps différé entre sites expert (CHU) et isolé (hôpitaux périphériques) avec une infrastructure moindre coût accessible même aux pays à faible environnement numérique comme le Togo. Matériels et Méthodes : Une technologie innovante de télétransmission (vidéos échographiques et d’ambiance) temps réel via internet à base de Caméra réseau AXIS 207 et de Serveur vidéo internet AXIS 243 dotée d’adresse IP ou un logiciel d’accès à distance (LogMeln) permet une télé expertise temps réel si le centre isolé dispose d’un échographiste peu expérimenté. / Introduction: Telemedicine generally, and telesonography in particular, is one of undeniable solutions to the problem of specialists’ shortage specially in developing countries with regard to the progress ceaselessly growing of the new technologies of information and communication. Purpose: Design and validate a .system of real time ultrasound tele-expertise, and delayed ultrasound tele-diagnostic between isolated peripherals hospitals and University Hospital center (Expert center) functioning with a lesser infrastructure cost accessible to low digital environment countries like Togo. Materials and Methods: An IP camera and an internet video server are installed in a geographically isolated site equipped with an echograph served by an echographist of first level. Real time tele-expertise (second opinion diagnosis) is possible via internet with an expert center.

Objetivo: Desenvolver e testar um sistema de monitoramento à distância por short message service (SMS) para pacientes com insuficiência cardíaca (IC) agudamente descompensada. Método: A elaboração do protótipo foi desenvolvida em três etapas: a primeira, foi a definição de todas as funcionalidades previstas; a segunda, procurou a codificação dos módulos do programa; a terceira, consistiu na realização dos testes, para garantir seu funcionamento pleno. O programa desenvolvido enviava dois tipos de mensagens: com perguntas, que deveriam ser respondidas pelos pacientes, e com reforços educativos, que não necessitavam de respostas. Além disso, o sistema gerava alarmes em caso de ausência de resposta ou conforme um fluxograma para detectar congestão. Esta dinâmica permitia o contato imediato com o participante para confirmar os dados recebidos e dar orientações sobre as medidas necessárias para auxiliá-lo. Para o teste do protótipo, foram acompanhados 10 pacientes com internação por descompensação aguda da IC que estavam nas unidades clínicas ou na unidade de cuidados coronarianos do Hospital de Clinicas de Porto Alegre. Após a alta, as mensagens que exigiam respostas foram enviadas durante uma semana (duas pela manhã e duas à noite). Os SMS educativos foram enviados uma vez a cada dois dias. Resultados: Participaram do teste do protótipo, 10 pacientes. A média de idade foi de 67±13 anos. Os pacientes eram predominantemente do sexo masculino e moravam acompanhados por familiares. A fração de ejeção média foi de 35±7%. Dos 30 pacientes potencialmente elegíveis no período de teste, 14 foram incluídos. Destes, quatro não tiveram alta no momento do teste e um não completou o seguimento de sete dias por internação por síndrome coronariana aguda. Dos 264 SMS enviados, 247 foram respondidos. Dez dos SMS não respondidos coincidiram com a falta de luz gerada por fortes tormentas que ocorreram na cidade. Os demais SMS não foram respondidos porque os pacientes não os viram (quatro) ou porque eles esqueceram (três). O alarme foi acionado sete vezes: três pacientes acordaram com falta de ar durante duas noites consecutivas e quatro pacientes se sentiram mais cansados durante dois dias consecutivos. Nenhum paciente aumentou dois Kg em três dias. Todos os pacientes tomaram as medicações prescritas durante o seguimento. A enfermeira do estudo orientou os pacientes que geraram alarme no sistema. Conclusões: O sistema de monitoramento à distância foi desenvolvido com êxito e, durante o teste, foi possível detectar algumas limitações – que foram corrigidas. Entre os participantes que completaram o estudo, observamos uma alta taxa de resposta e evidência preliminar de melhorias na autogestão da IC. / Objective: To develop and test a short message service remote monitoring system for patients with acute decompensated heart failure (HF). Method: The elaboration of the prototype was developed in three stages: the first one was the definition of all the expected functionalities; the second sought coding of the program modules; the third consisted of the tests, which ensured its full operation. The program sent two types of messages: questions that should be answered by the patients, and educational reinforcements that did not require answers. In addition, the system generated alarms in case of no response or according to a flow chart to detect congestion in the patient previously created by the team. This system allows the immediate contact with the participant to confirm the received data and to give the necessary orientations to him. For the prototype test we included 10 patients hospitalized for acute decompensation of HF who were in the clinical units or coronary care unit of the Clinical Hospital of Porto Alegre. After discharge, messages that required responses were sent for one week (two in the morning and two in the evening). The educational SMS was sent once every two days. Results: Ten patients participated in the prototype test. The mean age was 67 ± 13. The patients were predominantly males and lived with relatives. The ejection fraction was 35 ± 7%. Of the 30 potentially eligible patients in the trial period, 14 were included. Of these, four were not discharged at the time of the test and one did not complete the seven-day follow-up for hospitalization for acute coronary syndrome. Of the 264 SMS sent, 247 were answered. Ten of the unanswered SMS coincided with the lack of light generated by the strong storms in the city. The remaining SMS were not answered because the patients did not see them (four) or they forgot these (three). The alarm was triggered seven times: three patients woke up with shortness of breath for two consecutive nights and four patients felt more fatigued for two consecutive days. No patient increased two Kg in three days. All patients took the prescribed medications during follow-up. The study nurse guided the patients who generated alarm in the system. Conclusions: The remote monitoring system was successfully developed and during the test it was possible to visualize some limitations that were corrected. Among the participants who reform the study, we observed a high response rate and preliminary evidence of improvements in self-management of HF.

This study investigates how the implementation of the means of communication and Archiving Images - Picture Archiving And Communication System (PACS) could be used as information technology and communication (ITC) in medical education online. Assessing trends and potential of this new field of study, one realizes that its applications and benefits may not be restricted to medical and hospital environment, but also the learning environments using radiological images. Medical care at a distance through telemedicine consultation favors a second opinion when the distance is a critical factor, and allows many calls from happening online, for example, implementation and testing of diagnostic imaging. For this reason, one of the areas of telemedicine that have benefited most from this modality was radiology. Often the exams at a distance is the responsibility of a resident oriented so online by a specialist, as the project POA_S@UDE Hospital Materno Infantil Presidente Vargas in Porto Alegre, in the care of pregnant patients Neighborhood Restinga taking the examinations ultrasound. This experiment was assessed from a perspective of distance education, whereas residents involved in the project are doctors in training who work in a mode online, through questionnaires to specialists and residents who work or have been engaged in the project. The formation aspects of medical teaching, especially to work in online environments, development of assessment methodologies, interaction between the individuals involved, were evaluated to consider the experience to be used in medical courses as a means of distance education using PACS. / Este estudo investiga como a implementação dos meios de Arquivamento e Comunicação de Imagens Picture Archiving And Communication System (PACS) poderiam ser utilizados como tecnologia de informação e comunicação (TIC) na formação médica online. Avaliando as tendências e as potencialidades deste novo campo de estudo, percebe-se que as suas aplicações e vantagens podem não se restringir apenas ao ambiente médico e hospitalar, mas também a ambientes de ensino utilizando imagens radiológicas. O atendimento médico à distância por meio da Telemedicina favorece a consulta de uma segunda opinião quando a distância é um fator crítico, bem como permite que muitos atendimentos aconteçam de forma online, como, por exemplo, na realização e exames de diagnóstico por imagem. Por esta razão, uma das áreas da Telemedicina que mais se beneficiaram desta modalidade foi a Radiologia. Muitas vezes a realização de exames à distância fica sob a responsabilidade de um residente orientado de forma online por um especialista, como acontece no projeto POA_S@UDE do Hospital Materno Infantil Presidente Vargas em Porto Alegre, no atendimento pacientes gestantes do Bairro Restinga que realizam exames de ultrassom. Esta experiência foi avaliada a partir de uma perspectiva de EAD, considerando que os residentes envolvidos no projeto são médicos em fase de formação que atuam em uma modalidade online, através de questionários aplicados com especialistas e residentes que atuam ou já atuaram no projeto. Os aspectos de formação docente dos médicos, especialmente para atuar em ambientes online, definição de metodologias de avaliação, interação entre os sujeitos envolvidos, foram avaliados para considerar a possibilidade de que a experiência fosse utilizada em cursos de Medicina como um meio de EAD utilizando PACS.

Do superfast broadband and tailored interventions improve use of eHealth and reduce health related travel? Introduction – eHealth has been shown to have promising health outcomes in numerous areas, however many people remain digitally excluded and therefore suffer an inequality in health service provision. Lack of internet infrastructure, personal skills, and service provision have been identified as potential barriers to eHealth but as yet there is no good evidence of the significance of these barriers and the impact of interventions to improve them. This PhD aimed to assess impact on eHealth uptake of three interventions (i) superfast broadband, (ii) a tailored booklet to help participants improve personal internet skills and support, (iii) GP interventions to improve health service provision of eHealth. A subsidiary aim was to assess the impact on miles travelled. Methods - In a cluster quasi-randomised factorial controlled trial, 1388 households from 78 postcodes were sampled in 2013 from the 20088 Cornish postcodes and allocated to the 8 (2X2X2) arms of the study. A unique sampling method was used to prevent contamination between arms. Comparison of ‘eHealth readiness’ and ‘miles travelled’ from baseline to 18-month follow-up between the 8 arms of the study was used to assess the impact of interventions. Interventions were tailored based on responses from the initial baseline survey and designed using aspects of the theory of diffusion of innovations. An overall eHealth Readiness score (0-10) was obtained from a validated self-completed questionnaire combining four sub-scales (Personal, Provision, Support, Economic). The standard deviation of the eHealth Readiness score represents a measure of eHealth inequalities. Findings – No significant differences were shown between each intervention arm of the study, either singly or in combination (all p > .05). eHealth Readiness significantly improved over the 18-month trial period (M=4.36 vs M=4.59, t(235)=4.18 p < .001, CI=0.13-0.35). This increase is evidenced by increases in Personal and Provision scores (t(255)=3.191 p=.002, t(258)=3.410 p=.001). There was no change in eHealth inequality. The proportion of internet users, mobile use and happiness with internet speed also increased. Average travel to GPs did not significantly differ between baseline and follow-up (12.3 vs 13.0, t(251)=.44, p=.66). No correlation was shown between eHealth Readiness and total travel miles to GP practices. Discussion – Individuals within Cornwall became more ready to adopt eHealth services over the 18 months of study, increasing in both their personal ability to use eHealth and their methods of access. This increase did not cause a larger digital divide. However, this increase could not be attributed to any of the three interventions. Further research should focus on making use of the improvement of infrastructure within Cornwall and seek to implement eHealth services. The eHealth readiness of Cornwall should be assessed in a longitudinal study to understand the effects of time of the superfast rollout. Qualitative studies should take place on persons of interest to help design more effective interventions with the aim to achieve a societal drive to sustainable use and adoption of eHealth.  Contribution to knowledge – Previously internet infrastructure has been acknowledged as a barrier to eHealth. This PhD was the first to analyse the impact of a high-speed internet rollout alongside other interventions on eHealth readiness. The methods in this study were unique and provide the basis for further work, both in the creation of a sampling method to reduce contamination between cluster interventions and as the first time a measure of eHealth readiness and eHealth inequality has been used to assess the effectiveness of eHealth interventions.

CONTEXTO: O TelessaúdeRS faz parte do Programa Nacional de Telessaúde Brasil Redes. Entre os principais recursos ofertados pelo Núcleo está a teleconsultoria, definida como consulta registrada e realizada entre profissionais de saúde ou gestores da área. Para tanto, são utilizados recursos de telecomunicação bidirecionais, com o objetivo de esclarecer dúvidas desses profissionais, tanto clínicas, como sobre processo de trabalho ou ações em saúde. Essas teleconsultorias têm dois formatos: síncrona e assíncrona. O objetivo deste estudo é descrever o padrão de solicitação de teleconsultorias por médicos da Atenção Primária à Saúde do Rio Grande do Sul e determinar fatores associados ao uso das mesmas. MÉTODOS: Estudo transversal no universo de médicos, usuários do TelessaúdeRS, nos 127 municípios integrantes que responderam ao formulário de Linha de Base (n=334) no período de dezembro de 2007 à dezembro de 2011. RESULTADOS: Ser do sexo feminino prediz maior uso em comparação ao sexo masculino (RP=1,58; p<0,001). Idade tem associação negativa com o uso de teleconsultorias (p=0,02). As teleconsultorias responderam totalmente as dúvidas de 84,7% dos casos (n=304) e, em 339 casos (95%), os solicitantes ficaram totalmente satisfeitos ou satisfeitos com as teleconsultorias realizadas. Entre os profissionais que pretendiam encaminhar o seu paciente, 70,1% (n=164) alterou a sua conduta, evitando encaminhamento. DISCUSSÃO: A associação positiva entre sexo feminino e solicitação de teleconsultoria pode ser relacionada ao processo de entrada de novos profissionais. A proporção de médicas aumentou nos últimos anos, com a feminização da profissão, além de serem mais jovens. CONCLUSÕES: As características dos médicos que utilizam teleconsultorias para responder dúvidas estão relacionadas a ser do sexo feminino. A idade tem impacto negativo. O fenômeno da feminização da medicina pode ser percebido na população do estudo e, confunde-se com o processo de renovação da mão de obra. Esses fatores devem ser levados em conta na elaboração de estratégias de implementação. Apesar da satisfação dos solicitantes e, a evitação de encaminhamentos de pacientes, as teleconsultorias são pouco utilizadas. / CONTEXT: The TelessaúdeRS is a part of the National Telehealth Program Brazil-Networks. The main features offered by is the teleconsulting, defined as a registered consultation, conducted between health professionals or health managers. Bidirectional telecommunication resources are used in order to answer clinics, work process or health actions questions. It has two forms: synchronous and asynchronous. The objective of this study is to describe the pattern of teleconsultation request by Primary Health Care physician in the Rio Grande do Sul and determine factors associated with use. METHODS: Cross-sectional study in the population of physicians, TelessaúdeRS users from 127 cities who answered the baseline survey (n=334) from December 2007 to December 2011. RESULTS: Being female predicts higher use than males (PR=1.58; p <0.001). Age has a negative association with teleconsultation’s use (p=0.02). The teleconsultation fully answered the questions of 84.7% of the cases (n=304) and users were completely satisfied or satisfied with the teleconsultation performed in 339 cases (95%). Among the professionals who wanted to refer your patient 70.1% (n=164) changed their behavior, avoiding referral. DISCUSSION: The female association with teleconsulting solicitation may be related to the new professional’s entry process. The proportion of female physicians increased in recent years with the feminization of the medicine and are younger. CONCLUSIONS: Being female predicts wider use of teleconsultation to answer questions. Age has a negative impact. The phenomenon of feminization of medicine can be realized in the study population and merges with the process of renewal of labor. These factors should be taken into account when developing implementation strategies. Despite the users satisfaction and the avoidance of patient referrals, the teleconsultation are poor used.