Gestational Trophoblastic Disease (GTD) defines all pathological forms of placental trophoblastic tissue proliferation. Complete hydatidiform mole (MHC) and partial hydatidiform mole (PHM) are classified as benign and invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor are classified as malignant, called Gestational Trophoblastic Neoplasia (GTN) (1, 2). It is recommended that both in the initial diagnosis and in the post-molar monitoring, it is of paramount importance that the patient is followed up by specialists who are familiar with the measurement of the human chorionic gonadotropin hormone (hCG) regression curve, the in order to early diagnose the evolution to a GTN with initiation of treatment performed by chemotherapy, in most cases. Thus, when an adequate treatment is carried out, there is a possibility of a high cure rate and the possibility of a healthy pregnancy for the patient(3). In this perspective, diagnostic and therapeutic actions for the prevention of diseases and the recovery of health through correct decisions are based on in research, exchange of information and scientific evidence. The application of Information and Communication Technologies (ICTs), considering the quality, safety and efficiency of care, has a significant impact on the provision of health services and changes in the learning process of professionals, establishing a new “doctor-internet-patient” relationship(4).
As a result of the growth in the practice of digital health and the need for clinical follow-up combined with updated therapeutic approaches, the Ambulatory of Gestational Tropoblastic Diseases, pioneer of this project, by the University Hospital/Hospital São Paulo, Escola Paulista de Medicina, Federal University of São Paulo (HU/HSP/EPM-Unifesp), one of the Reference Centers in Brazil, specialized in treatment, assistance and research, undertook the construction of a HIS composed of two interfaces: a Website (reactive site) for the procedures doctors who, associated with an Application (MolaApp) aimed at patients with the diagnosis, contribute to the teaching-learning binomial(5). Based on this computerization, even if the access occurs in real time and/or remote, it can help treatments in different geographic regions, promoting a specialized coverage of health care that can be carried out by other Reference Centers in the GTD, existing in Brazil. In this way, the work described the development and evaluation of the usability of a HIS, for academic and assistance purposes. Our motivation in the construction of the HIS was intensified due to the frequent access to computers, tablets and smartphones, as well as the lack of published works that portray the interaction between two technological devices developed with simultaneous application, as tools to help in the treatment process in GTD. In addition, also by reducing time, cost and improving the quality of communication between doctors and patients.
Another important factor regarding the therapeutic resources adopted for the educational assistance of patients, their families and other interested people is the use of social media and digital platforms that enable pedagogical and innovative initiatives in health. Diniz et al.(6) reports the experience of online interaction, through a Facebook page, between physicians who are directors of the Brazilian Association of Gestational Trophoblastic Disease - ABDTG and patients with hydatidiform mole, in which positive results regarding satisfaction, security and understanding of information and guidance provided remotely.
With the awareness and knowledge of the existence of services with a perspective of improving care, distance services represent a significant opportunity in poor and remote regions, where one cannot expect specialized face-to-face care. The application of low-cost technologies is necessary and must be stimulated in order to implement integrated collaborative networks of remote assistance(7).
Technological Innovation – Digital Health
When it comes to Information and Communication Technologies in Brazil, there is the SUS Application (“DigiSUS”) - Portal of the Ministry of Health - which brings citizens closer to public health services and has a platform with 1.2 million downloads., between smartphones with IOS and Android systems(8). In addition, data from Brazilian National Telecommunications Agency -Anatel- indicate that in Brazil in 2020, there were more than 234 million mobile internet accesses. Brazilians have the highest average use of smartphones in the world: 4 hours and 48 minutes(8). In this sense, with the advancement of ICTs, mobile applications aimed at the health area act as self-management tools in diseases aiming at the process of self-care, which facilitates the achievement of clinical results in the conduct of treatments, a promising proposal for self-care at home(9).
According to the Brazilian Institute of Geography and Statistics - IBGE, the Brazilian population is increasingly connected. The data investigated by the Continuous National Household Sample Survey - Continuous PNAD, in the fourth quarter of 2019, refers to Information and Communication Technology, in the aspects of internet access and possession of a cell phone for personal use by people aged 10 years and over. In the period from 2018 to 2019, the percentage of those in which the cellular mobile network service worked, for the Internet or for telephony, increased from 92.4–93.2%, in urban areas, and a decrease of 68.5%. % to 68.2%, in rural areas. In these surveys, they showed that in 2019, in the population of 183.3 million people aged 10 years and over, that is, 143.5 million (78.3%) used the Internet. This percentage has been growing since 2016, as the data were 69.8% in 2017 and 74.7% in 2018. Internet use related to sex in 2018 - Men (73.6%) and in 2019 - (77, 1%) – Women in 2018 - (75.7%) and in 2019 - (79.3.%) (10, 11, 12).
Currently, cell phones are no longer used just for phone calls or to receive and send messages, as they are increasingly developed with advanced technologies and data storage capacity for the benefit of users(13).
At Paulista Medical Association - APM, a survey was carried out with 1,614 professionals to map the use of digital solutions in the routine of care in the state of Sao Paulo (Brazil), with 82.65% of physicians using technology in their day-to-day care – whether to observe patients or to optimize consultations. The purpose of this study was to map the use of technological resources in Medicine and Health where 67.66% of respondents agree with the phrase “Technology will not replace the physician, but it can replace the physician who does not use technology”. In fact, 93.68% understand that sharing information benefits everyone involved(14).
Furthermore, research related to the “Meu Pré-Natal” Application(, for women during pregnancy, childbirth and the postpartum period, has certified a satisfactory gain for the relationship between health professionals and their patients (15). In this line of research, the "Evaluation of Mobile Applications to Promote the Health of Pregnant Women with Preeclampsia", available on iOS and Android platforms, proved the possibility of verifying whether the tools are reliable, as well as whether they had consistent information for promote the health and quality of life of pregnant women(16).
Ethical and legal aspects
Recently, it can be highlighted that we have experienced two distinct periods for practical activities in the health area, since until March 2020 the legislation, standards and resolutions existing in Brazil did not clearly provide guidelines for health professionals, for the Health Surveillance of states, municipalities and the population about the risks and benefits of using Applications for telemedicine. This is because the topic was current and brought many controversies among professionals in the area.
With analysis of the timeline, there is the starting point with the Civil Landmark of the Internet by Law No. 12965/2014, which began to regulate the use of the Internet in Brazil with provision for principles, guarantees, rights and duties for those who use the network(17). In the same context, also, to enable the use of digital instruments in the health area occurred the enactment of Law 13709, published on August 14, 2018, with determinations on the General Law for the protection of Personal Data - LGPD(18), which provides on the objective of protecting the fundamental rights of the natural person. (28) And further on, with the advent of the Covid-19 pandemic, there have been relaxations in the procedures of the care provided. Both the Ministry of Health and the Federal Council of Medicine defined therapeutic guidelines that supported the insertion of ICTs in medical and other health care procedures. Moreover, the determinations of the Secretaries of Health of the States with social distancing, after the expedition of the Telemedicine Law nº 13989, of April 15, 2020, regulated attributions about general information and limitations inherent to the use of telemedicine, allowing video calls by WhatsApp or messages and other videoconference apps(19). Still, in this sense, it is necessary to point out the expedition of Law 14129, of March 29, 2021, since it establishes principles, rules and instruments for Digital Government and for the increase of public efficiency.
In view of these considerations, the question that guided the development of this project was: “What are the advantages and benefits of developing a System capable of promoting adequate post-molar follow-up and early diagnosis of its malignancy named Gestational Trophoblastic Neoplasia, through ICTs?”