Supplementary Material

SUPPLEMENTARY MATERIAL

MATERIAL SUPLEMENTAR)

DEVELOPMENT OF THE ICONF PLATFORM
 
In order to meet the new demands and challenges involved in providing Tele-ICU services to public hospitals, the Instituto do Coração developed its own platform, designated iConf, which includes the main web conferencing features of a commercial system but under an open-source license. The decision to develop its own platform was made to prevent potential conflicts  regarding leaks of sensitive personal data, such as test results and patient diagnoses. On the iConf platform, all Tele-ICU data are stored on a server at InCor and are not shared with or handled by third parties, as is the case with commercial systems.
 
The main resources available on iConf include audio or audio/video sharing; presentations with extended whiteboard capabilities, such as a pointer, zooming, and drawing; public/private chat; screen sharing and an integrated Voice over Internet Protocol (VoIP) using FreeSWITCH (https://freeswitch.org); and support for the presentation of PDF documents and Microsoft Office documents. Such resources are available through public domain libraries (https://bigbluebutton.org/).
 
The iConf platform was built with the standard HTML5 user interface and uses web browsers (Google Chrome, Firefox, Opera, and Safari) for real-time communications, such as sending or receiving audio or audio/video and sharing screens, through WebRTC. In addition to these features, the iConf platform allows recording of telemedicine sessions for auditing and traceability purposes, as well as integration with third-party systems through a standardized communication interface (Figure S1).
 
In order to use iConf, one just needs to share the URL defined for the telemedicine session, which can be done either automatically, using an external scheduling system, or manually by the operator. The defined URL can be associated with a date, time, and duration, as well as with a six-digit token. The URL and the token are both shared with those involved in the discussion; however, the URL and the token cease to be valid when the discussion date and time expire, ensuring that they will not be used in other discussions.
 
In order for iConf to be operational, telemedicine stations were set up with dual high-resolution monitors, a camera, an echo-canceling microphone, and an audio playback device. The web conferencing sessions between health care professionals are displayed on one of the dual monitors, whereas information from electronic medical records of the hospitals participating in the discussion is displayed on the other. In addition, in order for all variables of interest collected during the discussion of clinical cases to be recorded safely, following international standards such as the Health Insurance Portability and Accountability Act, all discussions are recorded in MPEG-4 file format. Therefore, if there is a need to review a case, all discussions are available for consultation.