In the late 1990s, the first e-health services emerged in Portugal – a country of 10 million people on the western tip of Europe. The department of paediatric cardiology of Coimbra’s Pediatric Hospital started its teleconsultation program with district general hospitals of central and northern Portugal to make highly specialised care – including dynamic imaging – available to the population.
This program was built on technology developed by Portugal Telecom’s innovation lab. Since then, this program has been growing and even crossed the continent´s borders as it also serves hospitals in Portuguese-speaking African countries such as Angola or Cabo Verde. Until today it has helped thousands of children in need of cardiology care.
In 1998, today’s largest Portuguese e-health service – called “Dói, dói – trim trim” – started its activity. It began as a nurse phone triage service provided by the National Health Service (SNS) to support parents when their child became ill. Since 2007 it also assists the adult population. Meanwhile, the name changed to SNS24.To date, SNS24 has been evolving to the citizen’s digital entry point to the SNS. It now offers a wide and steadily increasing range of eHealth services and is used by millions of citizens every year. Its citizen mobile app counts over 8 million downloads.
This has not happened by chance. Successive Portuguese Governments have been promoting the development of e-health through supporting regulation, financing the acquisition of information and communication technologies (ICT), and enabling reimbursement models. The Shared Services for the Ministry of Health (SPMS) assumed the role of a National Digital Health agency when established in 2010. Since then, it has been building a large number of ICT systems – including the citizen’s electronic patient record – as well as the already mentioned SNS24´s eHealth services. In 2016 the government launched the National Telehealth Center (CNTS) within SPMS to actively promote the creation and adoption of telehealth services. CNTS wrote a National Strategic Telehealth Plan in 2019 that was ratified by the Parliament.
The five most popular eHealth Services among Portuguese citizens
Portugal launched ePrescription in 2015. Patients receive their prescriptions via email, SNS 24 app or SMS. Today, over 97% of prescriptions by public and private providers are issued digitally. ePrescription has also turned out to be a crucial enabler of telemedicine services such as teleconsultations, which would often be incomplete without the possibility of prescribing medication remotely.
Portugal also belongs to the first set of European countries that digitally enable its citizens to obtain their medication in a pharmacy located in another EU country.
“Exames sem papel” (exams without paper) is the name given to the digitalisation of the complete circuit of exams, such as lab tests within the SNS. Patients receive their family doctor’s prescription by SMS, email or on their SNS24 app. They can then choose a convenient nearby lab and will get the results on their app as soon as they are available. These results are simultaneously integrated into the citizen’s electronic health record and made accessible to the assisting physician. From May 2022 to January 2023, almost 23 million results were electronically shared this way.
Citizens who feel acutely ill can use the nurse phone triage service provided by SNS24 to be directed to the care they need. SNS24 nurses performed more than 8 million assessments in 2022 and referred citizens to self-care, primary care, urgent care, or the national emergency line.
SNS24’s digital symptom checker has registered more than 4 million users since its launch in February 2019. Both services were central pieces of public health management during the COVID-19 pandemic.
Physician-to-patient video consultations have existed in Portugal since 2016. However, this time it was the private sector that led the way. Private health insurance backed this through reimbursement.
Today teleconsultations are a common practice in primary care and private and public hospitals. Healthcare insurers and new digital native providers have joined the healthcare market, also offering virtual care.
After a steep increase pushed by the pandemic, teleconsultations have decreased significantly but have settled at levels many times higher than before COVID.
5. Electronic vaccine bulletin
The digital vaccine bulletin has been available to citizens in Portugal since 2017 and is accessible via the SNS24 app. It does not only keep records of vaccines already administered but also shows the upcoming personal vaccine schedule according to the national vaccination plan. Thus, citizens can ensure not to miss any recommended vaccines.
There are many other e-health services, such as primary care appointment scheduling, COVID-19 vaccine scheduling, or requesting a prescription for chronic medication. All the applications make the life of citizens in Portugal easier every day.
But not every citizen has digital skills or access to a smartphone or broadband internet. For this reason, the Ministry of Health, together with the Ministry of Justice, the municipalities and the social sector, has set up access points equipped with the appropriate technology. Trained assistants help people to use the available e-health services on-site. There are already 339 of these SNS24 counters in municipalities, prisons and care homes across the country so that no one is left behind.
Source of the data: SPMS E.P.E.