Cuidado Contínuo: A Nova Fronteira da Saúde Digital

If we discuss here, in the second part, there will be a part that everyone will participate here too, to create even maybe a letter, a document in which we will put all the

the challenges that are ahead, because we are no longer the technological problem, I think there are several borders and we are the health elite in Brazil. I think we are here within the HC, there are few doctors and few professionals who work with innovation, who can work to break the health avant-garde in the country.

and we are here. So I think it's a little bit of dressing, putting this responsibility on our shoulders a little bit and that's what we at Next Run are thinking about building, right? I start to build there, where do we have to go? Is it just collecting data? How are we going to collect? Is it bracelet, ring, necklace? What

So, it is with this objective that we welcome you here, with great joy, in the name of BSS,

we are also from NETJUAN, we are very happy to be in this event that ABSS is starting to promote in partnership with the startups that are part of our ecosystem, we are also as a startup within ABSS. So, welcome everyone.

It's a pleasure to see you here on a game day. Unfortunately, we didn't win. We lost again, but it's nice to be here at HC. It's a great pleasure to be here at HC, together with the university. I think that's where the innovation comes from, it goes to the private sector.

and it's a very sensitive topic, even because some of us are very close to 40, I see that all of you are close to 40, so it's a very important topic. And the second part we're going to do a different "Pinga Fogo" because we really want to generate a report, a paper about it so that we can really impact the market.

So, welcome to the HC, this is your first time here. Here is an open environment, we hope you are here, we see that you are here. There are always events, both from BSS and from Inova HC, and it's close to research, and close to the university makes a very big difference. Claudio? Yes, Andy.

I think now there is an institutional presentation from the ABSS, for those who don't know, Cláudio, our vice president, is here, our president, Bruno, is back there, from the ABSS as well. Thank you, Lívia. Good afternoon, everyone. Lavel, thank you for the opportunity to be a partner.

My name is Raquel Adagio. I'm the vice president of BSS. I'll introduce our association. Who doesn't know BSS? Who knows it or doesn't know it, it's a health tech, a startup, and it's not associated with BSS.

So, let's go. SS was born in 2019 as a Brazilian Association of Health Startups. When we take over this management, we put the "E Health Techs", because in our management, every health startup is a health tech, and not every health tech considers itself a health startup. So, when we make this movement, we expand our market a lot here.

We have the figure of the maintainers, companies that are not necessarily in health technology, but they want to explore our ecosystem, and then they have a greater visibility within the ecosystem and support from our management in the business generation of these associates, of these maintainers. We are talking about a...

So we have an ecosystem of associates, companies that support us, people from more or less 400 entities within our ecosystem.

This is our statutory board, elected at the end of 2023, with a mandate valid until the end of this year. This is our invited board, we are all volunteers, no one is remunerated, so we have a board well related to the market, to be able to help us make deliveries.

This is our hired staff, especially here Lourival, who is the only one who wakes up and goes to sleep thinking about BSS. We have the other partners. Speaking of purposes, we represent and defend the interests of technology-based companies. In our ecosystem, we have startups, half-techs, physical people, and what we call an ecosystem company, which is a company that

can explore everything that an associate explores, they just don't vote and don't select. It was a way for us to open up our universe of associates.

We have partners that give direct benefits to the association and our great supporters are the companies that organize the great health events here in Brazil, where the BSS normally exposes the association and its associates. In a word, BSS is access, access to the pharmaceutical industry, health operator, government, that's what we provide for our associate.

We have some benefits, among them, credits from AWS, all the strategic network part, we do matchmaking between a startup and an associate, together with the hospital, a health operator, who has to develop relationships. It has a great relevance in the government relationship, we talk quietly with the signed chamber, the health ministry, including the waste project, the blue receipt,

It was done with BSS and AMMED, together with the government. Every month we have a hybrid event like this one we're doing here, always a topic of interest to our ecosystem. Our associate can work here within Nova HC, including the option of having a tax address here within Nova HC. Rio de Janeiro has a partnership with Arca Hub in this model as well.

and

one of the great deliveries that we make to our associate, any of our associates exposes their solution within the BSS booth at any event that we participate at, without additional cost. Here illustrating some events that we came to participate in over time. This was our second hospital, this year we already had a participation that was Plaza BSS Bairro Hospital, a much larger space dedicated to us,

Here was CONAP 2025 with an island of BSS and some startups around. And I highlight the startup that has resources and goes to buy a stand. The one that doesn't have one, exposes it inside our space without additional cost. Here to comment for you, we have an area of 200 square meters inside the RIS, an event that will be now in September. This is just a sketch, but it will be an area

potentially one sponsor or four sponsors via BSS and 30 to 100 startups within this space together with us. At CONAP today, we just closed this, we have an investment for anyone who wants to be at CONAP, the National Institute of Privacy, being associated with BSS, an investment of R$ 7,000.

which last year was 12.5. So it's already a great facility for our associate. Today we are doing the curation of 100 free stands within Fizz Week, which is in November as well. And then just to close for you to have an idea, an associate of ours participates in the BSS with an investment starting from R$ 1,800 per year and with an investment starting from R$ 6,000 per year, he has a matchmaking where we guarantee connections

are committed to that customer profile that he seeks within the association. There is also the maintenance, which has other benefits, especially visibility, and that's basically it. Thank you. If anyone is interested in more information, just look for me at the end of the video.

It's a pleasure to bring some friends here, future friends too, to the panel. So, Dr. Rafael, although he is R1, he is 20 years old, he is taking an important area at DASA, you can come. Bruno, he's fine. He's taking a... instead of introducing what he's doing, but it's a very interesting neural journey. Our friend Victor Luciano, who is from Santa Rita.

We will not turn on the padlocks.

talking about continuous care, we see the patient in another way. I'll do a round of you to introduce yourself, before you start the questions. This is cool, we brought a big laboratory, we brought a hub, investment, and we brought a hospital, we are using a reference hospital to talk, so I think it will be interesting.

Good evening everyone, sorry for the voice, I'm getting out of a flu. As Cláudio said, I'm a "rhyumbre", I'm a trained doctor, I'm a gynecologist here at HC, here at Necla, in Einstein. Today, in addition to being a doctor, I'm a data scientist and researcher in machine learning here at LabDaps.

of the University of Public Health of USP, my doctorate there, and at DASA I stay in an area of research and innovation with data, where we do partnerships with Health Techs, Biotechs, Pharma, etc. to extract data value and generate both value for these companies, but mainly for the patient, right? We are researching and trying to create, build

journeys, do a journey of P&D, of models, understand epidemiology of diseases here in the Brazilian population. NASA dispenses presentations, but just for you to have an idea of ​​the amount, we have contact with more than 3 million people annually in our units. Well, I'm Bruno Pina, for those who don't know me,

I'm a doctor, I graduated in technology, my career was in the technology market, financial market and then in the consulting market. I went from IBM Global, I built IBM, then I went to McKinsey. I left McKinsey to take a position as executive director at AstraZeneca until the pandemic. I started in Brazil, this Nova HC project was a primordial project in my area.

where I invested here in the past some dollars and took Professor Giovanni and all the staff here to China a few times to build the vision that would be the new HC. So, coming to CAE is nostalgic. After I left Zeneca City in 21, I was already working for the international market, I worked for India, for China, for Russia, for South Africa, Israel, several countries where I built ecosystem of acceleration of health businesses, where pharmaceuticals

I participated in a place beyond the treatment, the discussion was not about selling drugs, it was about extending the patient's journey. When I left there, I started working here in Brazil,

in projects that connected the chains of the chain. And by doing this I stayed at the Lebanese City Council for a year and a half, then I still work with big pharmas, employers and governments here in Brazil. In the last three years I was invited by a large and private health group here in Brazil to build a longevity hub based in Portugal.

where, within this hub, we have a structure that orchestrates and navigates the pain of the public and private health systems. We have a longevity clinic in Cascais, and we also have a clinical and diagnostic clinic network, for example, and other different activities that complement the prevention and early diagnosis journey, which is the longevity theme. So, that's it. It was a pleasure. Good evening to everyone.

I would like to thank Flávio's person, the opportunity we have to get to know each other and work together on some initiatives. The invitation is here with Renato Algarci once again. My name is Luciano Pessoa, I am a training doctor, I am a cardiologist, interventionist cardiologist, but in the sequence of my life, even because of the intervention, right at the beginning of the career you have to work in management.

I have a team, I am the coordinator of a team of hemodinamics, cardiac catheterization in the heart hospital and soon you have to learn management. When I finished my training in medical residence, I did an MBA in hospital administration to start this in GV in 2012. And the career was following in this context until I also entered the hospital Santa Rita, where I structured some units, including the innovation directorate

and this is a project that we have been working on for about a year and a half, now two years, which is the Directorate of Innovation and Artificial Intelligence, which was a project that had the opportunity to grow and present itself in several partners and build solid partnerships, as we have discussed with Flávio there, once again, it is an opportunity that we are here learning and sharing knowledge. Perfect.

I always joke with Rafa because if it's longevity, this guy has the recipe here. I think it's amazing.

And when we're talking about continuous care, it seems to be a simple thing, and it reminds me of the chronic patient, but I think we've already left this page aside. How do you see this?

integration, monitoring, both the doctor and the patient, the institution, of this continuous care of the patient. And being together, Rafa, in your vision of doctor, laboratory. Well, first, it's really cool to be here, right? I think we already have a trajectory, thanks to the invitation of Dr. William, Mr. Flávio and the themes you bring here are always very cool.

the question of how it is being this as I have seen this is a change a shift of mentality of attention not only in disease but attention to health how I can not only treat but generate more health and then longevity is very much in this context when I think of diagnosis

We have several new diagnoses emerging, there is the genomic part, the part of biological age being measured by several other patterns, from machine learning to taking pictures of the face, to identifying biological age, even genomic exams.

as the part of the telomere. So I see this mindset a lot not only in medicine, but in the general population, looking for more of that, wanting to take care of themselves and not just treat diseases. And it's something that was even said by the professor at Inova USP, who told me this concept for the first time, Arthur, which is when you are in entrepreneurship, you have those problems, those burning hair problems. So the patient, the client,

does everything to solve this problem.

and aesthetics, oncology are health burning hair problems problems and I see this question of seeking for well-being also becoming something that patients are trying at any cost and that's cool because it generates this whole ecosystem trying to integrate diagnostic solutions, next-run, running, etc. to generate health and not just treat disease.

This subject is very good. You will know that I am a very rebellious person at this point. I didn't even comment, but I'm a member of the League. So, for four years we were at the HACMED doing a lot of different things, provoking intrinsic education in those who can really change the health system from inside to outside, which is the doctor, the care of the patient. And when we talk about continuous care,

I think that if the governments, the private entities understood the real challenge and the change that has to happen to make continuous care, many would not be talking. Because continuous care will make you see the episodic health system as predictive. The whole health system is built on the episodic. You have a problem, you don't talk. You have a disease, you do something. Your watch detects something, you do something.

When you work on the care of the patient, you can't just look for an episode. You have to avoid that the episode happens. To do that, you have to work with layers of data and behavior analysis that are not within the health system today. There's a data, 90% of the important data for someone's health is not in the hospital, it's outside the hospitals. It's happening on a daily basis. So, to open this conversation, there are these three actors that you brought, the doctor, who doesn't know how to take care of the patient.

The doctor is educated with care to prescribe, look at the patient and be efficient in analyzing everything he has to say. This case will be a mental tree to try to identify what episode of pain he is going through. And when you don't have an incentive in the health system to deal with the continuity of care, it gets even more difficult. You are not covered by a health operator, you don't pay to do it with a medical care provider.

So that's the doctor's point. I take the patient and that's the other poor thing, us, right? Because we are not educated, not even in school, not even anywhere, and we are responsible for our health. We delegate our health to someone who will take care of it and I believe that I do better than I don't know how to look. It's changing, we can talk about it soon.

And the third point is the health institution. Each health institution, each cell has an indicator. A success indicator, a result indicator. If you put together some cells in the chain and confront them, one indicator is the success of the other. So the system is not tuned for an approach where continuous care happens. Because continuous care is us leaving the episode and talking about value chains. Value chains are about some cells that earn a lot of money today, earn less, and those that earn a little money, earn a little more.

I'm almost speaking, stop speaking. The provocation is that continuous care and longevity will lead us to a discussion that will reform the health system. I don't know if I'll be alive yet, but I think we start to lock this up because the event that happened to lock this up is the health system around the world breaking. So it's almost unsustainable. And that's what I like about the conversation.

When you put the issue of chronic diseases and we talk about continuous care here, I think the system started to change, the mindset started to change. I remember that before the pandemic, PricewaterhouseCoopers, WC, did a very interesting study. It did a simulation based on

health promotion, putting the patient in the center, as we say in the quality accreditation models, patient-centered care, but it's not just that, it's not just the doctor taking care of a passive patient, it's self-care. That's one of the trends that Yamaquim also put there at the beginning of 2020, which would be health trends.

The patient had to stop being reactive and start being proactive. And health promotion, Flávio, today is, from conditioning to health, but from you having good care for chronic diseases, and we have experiences today, like the Massachusetts General Hospital in Harvard, of more than 9,000 patients in acute care.

cardiology, oncology, obstetrics and even small surgeries, the concept of "host-palate home" that Bruce Leff inaugurated. There are more than 9,000 patients and today we have a reimbursement study with more contribution, the model already working because we have evolved from the phase of just the concept to the phase of going forward. Remember that this study from PricewaterhouseCoopers went to diabetes.

showed a potential reduction of 15% of the cost in this line of care if I worked with diabetes in this way.

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to finance health in that country and yet the main cause of AVC in that country, which is a disabling disease, is hypertension and the lack of knowledge of patients to take care of

basic high pressure that we suffer here in our country for them is very serious and the main cause of AVC and swelling as we can put it. So when I talk about self-care, about getting out of this mindset of being reactive to be proactive and I put the patient in this value chain, I go to another place. This experience in Harvard

in Boston is very interesting because it shows the potential of this. They show the potential of reduction, it's not that they show the potential of reduction, they already have the numbers, because they have already rolled the patient's number. 30% reduction in acute care. When the patient no longer comes to the hospital, what happens then? You have to have a method for that. You have to develop a line of care.

So, the care is developed with professionals, with technology, with multidisciplinary assistance to build a new model. It's a new model of care. And the patient has to be in the center of this model. If not, what will happen is that we still suffer a lot in Brazil. We still spend a lot of money.

We have a lack of funding in Brazil, of course, but we also have a lot of interference, a lot of inappropriate use of our money. You have seen if you were able to be there in the public health system. We are here in a high complexity tertiary hospital, focused on education, where the losses and inequities are minimized.

But when we look at the system's account, at the basic health unit, at the UPA, at the entertainment unit, we see how there is poorly employed money and that it doesn't bring good results. This point is very important. Is there anyone from the operator? Just to make a comment here. Anyone from the operator? No, I think this point, there is someone from the operator missing here, right? Because the model really needs to change because it's for resolution, right? Not because...

I can interrupt you to talk about an operator that could be in different places. I'll interrupt you just because we need to put this fourth player. If you talk to Paulo Chapchato, for example, he talks a lot about this. We have to evolve to a moment where we will have a forum where these four players will be talking.

You have to have the patient, the operator, the suppliers, which are the hospitals and clinics, and the government making the regulation of this. There is a project in which we participated in the Heart Hospital, where we took care of the geriatrics and we did a program of "captation" for geriatric patients. So we reduced hospitalization and use of the hospital by 30%. Then you say: "But this was not good for you, you as a hospital reduced the use

But it was good for everyone. The operator won, she reduced 30% of the cost and I did what? I fed this patient. This patient comes back to the system more often and uses the system better. So there are many interesting projects because, as you said, we need to associate the players who have method and who have financial resources and who have interests and needs, because otherwise the solution will not come out.

Exactly. We had a discussion with the operator, and he said: "No, the guy leaves here two years and we don't want to touch him anymore." We can't think that way. And passing on, what kind of data outside the hospital do you think is relevant to really work on this continuous care? What should we monitor? Because the "I am the patient" is no longer the management of life. What data do you think is relevant?

Just to close this point, I'm being very simplistic here, but just to add, I think there are two points of view that add up. One, I think there are a lot of people here, there is a private market of people

who have resources and have this commitment to seek for taking care of themselves, for health, etc. which is growing, that's a fact, people are drinking less, the male generation is looking for physical activities, etc.

And there is this issue of the health system, which is mostly health care personnel. And there at DAS, we recently went through a very difficult process because of that. We tried to set up a network

trying to put Value-Based Healthcare to work here in Brazil, it didn't work out, so there's a whole system of incentives that prohibit us from going after this healthcare, and then we have to go back, we ended up separating hospitals for diagnosis,

Amil joined, founded Américas and now there is Américas, Amil, DASA, who talk, but in different companies because of this difficulty and lack of incentive of the system that we have today. So it's a conversation, as Bruno said, it's the way, I just don't know how far we're going to get there,

and I always provoke people to think about incentives, right? How do we adjust the correct incentives for us to walk faster to this system that is already very much discussed, already taken in some other countries and ends up being more beneficial and more effective cost. Today we live in a moment where the health cost only grows, if we don't prioritize the cost-effectiveness we will certainly

Now, going to the data side, which is my great passion at the moment. It's hard to answer this question, Faro, because there are so many things. I was in a discussion with Einstein last week,

And we talk a lot about climate, so adding climate data to see cardiovascular problems, respiratory problems, even the issue of the epithelium of the vectors that transmit, understand, and so on.

So there are so many sources of data that can add up. It's obvious that the error bot ends up being something more

It's easier to show that it makes sense, right? The sleep is there, I can extract information from it, the beats. I had a case even with me, my father has an arrhythmia problem, I started to have some beatings, then with Carlinho I managed to do the electrical there in cardiology, he said: "Here we have to do it, but here it calms me down because it really

It seems to me to be just an ester system, but I did the tests here. I think there are many sources and the big dilemma that I live daily today is how to connect these silos. I think this is the key, we are having several solutions, we have an LGPD that is very restrictive,

and we are trying to navigate paths to increase the linkage, the gap in research, so we can extract more value. The value in health data is much of the longitudinal journey. So if we can't connect these points, the value will drop a lot. Within the projects we are building today in Portugal, and even some in other countries,

This data agenda is a constant conversation.

We have had, we have participated in some conferences in Europe that deal with the topic of wellness and scientific wellness, where these data that were previously only about wellness because it is an easier regulatory route, it starts to be looked at as "opens, is there something that I'm not investigating, but within a health system that believes that everything needs evidence, there are still many things in health that do not have evidence?"

the discussion was like, where does science find wellness? What data is this that you're capturing in wellness? Because you want to run better or because you want to do some kind of heart rate assessment and where does that find science?

It has been one of the vectors that we have with many biotechs, we are talking about a biotech from the Netherlands that has done something similar, there is a biotech from Israel. Now, what kind of data is so complex? Because if you look at the stratification of the population, you will find different data.

SEP is an amazing data. So, if you take there, there are several studies, including one from Professor Giovanni here, beautiful, about the cost of a patient in Paraisópolis, this 500-meter walk in Morumbi. These things I think we are not yet, we are still giving the shots of the double diamond of design thinking, we are still diverging, I think we have to start converging.

If you go to other countries that have been implementing this for many years, to evaluate a lot of data, I say that if you want the future of health, you go to two places. You go to China, or I like England, technology is not a service, or Israel. But if you go to China, the future here, even in the south of the globe,

You'll see that all companies that are working with home care, that are working with data on health care at home, they are starting to say: "Look, it doesn't make sense to dress the patient." They spent tons of money in Chile dressing the patient. They have to start dressing the house.

Because the patient will take off his clothes, he doesn't want to stick it with a watch, with a cap, he will even use it when you have an incentive. It is a layer of the population that has an interest in this self-dressing and that will use it to proactively take care of themselves.

So that's the point. So there, for example, they are starting to visit the house and also understand that you ask for everything in the app and a staff is starting to do everything via voice. 85% of the health communication at home is via voice. It's no longer opening the app with the notification. That's the point.

And the second point that I think is worth continuing the conversation here, interesting to analyze, is the point of, within all the models that have been built in health, where it is that, really, excess data makes more sense than less data. Did we need to see all the watch alerts because it changes any data? Or you, as a lay patient, ignorant that we are, should only look at what comes out of your meds?

An athlete who has above 50, I don't know, above 80 heart rate, he has a health problem. I don't, I don't use an athlete. Because the basalt is a euro. So, without context, you can't measure your data alone. And sometimes what these tools do, investibles, is give you isolated data, and not give you the context. And then you have a big problem here, the integration, where is this data, where the patient fits in.

It's a complex conversation, it's not conclusive, but I think there are these aspects of looking at what wellness is. And then, yes, say, "this wellness data here I wanted to investigate." Then you go to science, you do research, do a prospective study, do a more complete work to even remove a little of the barrier of distrust, because there is no scientific validation.

.

I'm not a doctor, but as a student, I'm a nerd, I study it a lot, my colleagues at AI work with me, they help me understand it better. There are things for us to understand. And when we talk about practical applicability, what we are doing today, for example, with the Lisbon Chamber, with the Cascais Chamber in Portugal, we are designing a program for monitoring indicators that they can capture in the UBS, called LS. Simple.

If you want to dress a patient, put him in a health care unit, dress him, there you get what you want from him, but saying that you are going to do this in public health, especially, is more complex. I think there is a niche that can pay for this, for this robust wellness, right? Information health makes a lot of sense in the United States, super power is a good thing in the United States. Centene tried to do this in Brazil and just announced its failure.

So you have to understand where you are to see if this American data makes sense in Brazil or makes sense to look at the reference from Brazil. I think it's more England, that the Real Fetor Homo A has been working since 2022, it's an order from the government that every 100,000 inhabitants you have to have 50 virtual lenses to intern the patient at home.

It's a long subject, but I think I would stay on this line just so I don't lose my point here. Well, science is the answer, and it's a fire, you know, who sees more is more. I'll answer initially what you said, but I'll go back a step later. There are two places. First, I think we have to start where the data is fact, and not necessarily by strategy, because they are facts.

and where they are poorly used. We have two large groups of data, widely produced by society, spontaneously, and that are poorly used and that are important if they are used in an adequate way. The data produced by the patient in terms of vital signs, that we have technology today that we use not to take care of health, but we use because we use. For example, the cell phone today is something that makes a connection.

That's why it adds so much value. So, in your watch, today you have a smartwatch. So, the data produced by patients is produced in real time, all the time. But they are not worked in a method. Another big pool of data, very poorly used and that is difficult to deal with, even for

of the General Law of Data Protection in Brazil or abroad, where I have a conflict of interest with regulation, are the data that patients use, that they produce in laboratories, in radiology systems. Imagine, I am a cardiologist of training, I am one of the people who is more against what my profession does.

There is no reason to do a 35-year-old human being with an ergometric test, with an echocardiogram every year.

This is done widely. Twice a year you get a blood test, this is normal, I'm not talking about what is out of the norm. Health care providers have a lot of problems with this, but they don't touch on this subject directly, even because of how to explain the whole conflict. But look, there is a large number of data being produced and poorly used. Now I'm going back, before we explore these two points of data. We have to create a method for this.

First, I like to talk a lot with Jackson from Amazon, because I like to explore what other industries do, because in the health sector, I want to think outside the box. So how does the banking industry work on its challenges? How does the aviation industry work on its challenges? How does the entertainment industry work on its challenges? Employing technology to solve problems. Second point, using scientific methodology.

The first electrocardiogram started with three derivatives. Today we have an electrocardiogram with 12 derivatives. Today we have smartwatch studies to capture not only arrhythmia, but acute myocardial infarction with just one derivative. So I have to delimit my data. I start with care lines or simpler data, for example, basic vital signs such as heart rate,

if the heart rate is irregular or not, the highest limit, the lowest limit, for example, blood glucose levels, non-invasive, oxygen saturation, and I start to employ the computational power that I have. See how interesting it is. I know a little about the DASA model. It was very interesting when DASA bought the Santa Cecilia group.

a laboratory hub, image exams, start buying hospital suppliers and to close the cycle you also start working in primary care, you buy the Santos Cecília group for that.

And one of the big projects developed at DASA is the big Data Lake project, which you know there, which has a lot of production. For example, you do a tomography and this tomography has an alert signal that the human being cannot detect, the radiologist cannot detect. But the machine learning system running models of both machine learning and deep learning can identify patterns and can call these patients

for care lines, etc. There is a lot of data produced in this sense. For example, a simple electrocardiogram can reveal more than 30 pathologies that have nothing to do with cardiology today. Studies that use artificial intelligence in its various modalities, not only generative, but machine learning models, show this. So this data is already being produced. Now look, what failed, for example, in the DASA group,

We have to identify why it failed. Did it fail because of lack of funding? Yes, one of the things is lack of funding, because the system today, as you said, is fee for service. I pay, I receive for what I do. So the operator, the doctor, the hospital wants to do more to receive more. It is not the payment for performance as it is advertised in the United States, which has not yet reached the limit of this model.

For example, what is also failing today? We don't have models yet, we didn't have computational models like we have today. From 2016 to here, with this Data Lake and the computational power for IA, you can access petabytes of data in a millisecond. See, the heart beats at 12 milliseconds each beat. You can access a petabyte of these data every millisecond. These data are already there. The question now is to use the method.

So I would start there, I would take the data that already exists, that is already being produced and work what I have to start, like this: models for diabetes, hypertension, models for heart rate and other models, as we said in geriatrics, worker health models, models of who is promoting their health, athletes, informal athletes,

I would start there, these data are available, but I need to organize myself and organize the paying funds and the data providers and put the patient next to it.

I think the biggest question that you are asking in my mind, right? I'm already entering the data question, but it's how to solve these silos, you know? Because several top organizations already have this kind of organized. They had the computational power that is now available to almost everyone here. I think they will advance very strongly in this.

Institutions that didn't organize themselves will be sent. They will have to use IA to organize first and then try to extract something useful. And then I enter the question, since we have data, which has already started the question. I think the speaker will be working at the base. At what point do you think the data ceases to be information and really becomes a decision of care?

It's my area in the data, I'm in the real world part of it, both the predictive data, the patent, biotech, internal. Everything you said is true, we have a unique data lake, we have a lot of volume.

and it's all there in the lake, right? Health data are complex, so we have all the effort, the giant, the core, to make a whole layer of harmonization, right? So we have the hemogram, the São Paulo hemogram, we have the São Paulo nucleus, we have the south, we have the west, the methodology used is different, so there's all this drama, and in diagnosis, where we have four large groups of data, which is pathological,

clinical analysis, genomics, radiology and some image exams, it's already a little easier than if we go to a hospital that has enormous complexity.

um

So we can talk about the data here with the Earth, with Japan, with China and the United States. This is fundamental for us to have a standardization to pass to the scientific method later.

And we already have some very interesting cases, we have the Gardner Award, which is the largest innovation award, which was even in cardiology, which we did with Eletro in partnership with Neomed. So we are looking for partners, startups, companies, so that we can move faster.

And the methodology, we are very, very rigorous there, because dealing with, imagine comparing with other types of business, you go to finance, you have all the difficult regulation, but at the end of the day you will lose some exchanges if you make a mistake. You go to agro, you will lose some money, health we are dealing with lives, so we have to put the bar even higher.

and besides that we have the Ethics Committee, so there is the LGBT part, there is the compliance part, there is the CAD, there are several things and there is the Ethics Committee that we have to always pass and we have worked a lot in a layer of harmonization, standardization, in strategic partnerships with Big Techs, with Health Techs, with Brazilian startups, with Pharma, internally with our doctors and specialists.

and there is the part of accelerating all these bureaucratic processes that are important. So, from having more confidence in what we already have internally, making the links between bases in a safe way, with GPD, with Poing, etc. and having a

um um um

is already a model of data that is already anonymized, so there is greater security in relation to the ethical part, but even so it has to be submitted and sometimes the committee is not very adequate. So all these expectations we are acting to be faster, we can deliver value both in the part of epidemiology, in real-world research, as well as we start to take

the predictive models, which I can't fail to mention,

and it ends up being a great part of my life today, a doctorate is something that came to stay and now we have to pass from the part of scientific validation and try to start putting some models into practice that have been effective courses showing the gap of journeys and care and also helping this new generation that is forming

not only go to the market knowing, but using these new treatments. I'm going to be brief, but I'll give an example of what happened in our clinic in Portugal. But to answer your question, when the decision is made by the clinic, for me it's when you have context.

If the context is given, it is given, as I gave here the example of the real life. We have a clinic today, a longevity clinic, all longevity protocols that exist, prevention and early diagnosis, and within that there is a platform that navigates the patient, orchestrates his or her life outside the clinic, at home. And there was a specific case of a patient who was in pain.

the stomach is uncomfortable, temperature a little higher,

In theory, it was an unusual data. When he went to the health counselor and told him about the application, he said: "Look, I'm with a dose of this and that." His context was a patient who had some exams, he had had stomach contractions. There were some data that showed that it could be within an AI that analyzes the care lines that he is inserted. He was in a care line that had the active here. When he said the data of stomach discomfort, high temperature, with the data he had, he was potentially

a problem, a pain in the appendix. He would travel, at the end of the day he thought: "I don't want to travel with this pain, I'm worried." He goes to the hospital, we direct him to the hospital, which is the clinic network, which is a partner, and we take him there with the appendix supurated. If this guy travels, this guy dies. So, in theory, it would be a visual data, but a context data, you know who the patient is, you know what his data are, and it becomes a critical data.

And doing this is not simple. And then it goes to the second point, to this more contextualized answer, which is: with health coming home, with health decentralizing, which is what will happen, because treating the patient within the clinics is expensive, and this is a response that I had here in Brazil, as I said, in the prevention department, I said: "Pina, the hospital will never invest in prevention." So, why is prevention expensive? How do you give it to the hospital?

Look at the analysis, for a medical data that is real estate, for a care model that you have to generate results based on real estate, prevention is expensive. And it's not wrong. So, where will prevention be done? Outside the hospital.

So, with health going home, the theme of the data, the context, will become increasingly important. So, it will be a great challenge to unify all this, whether it's a data that a data captures, a data that a platform like this of care captures, even though they are isolated. Nowadays, there are sleep platforms, race platforms, and sometimes a data of a race, of a patient who did a bioimpedance at the beginning of a test, a race, can be a crucial data.

The checkup of my daughter with the gynecologist can be a crucial data. The gynecologist is trained and does general treatment, a family doctor, so sometimes she will see a data and will ignore it because it doesn't make sense. So I think there is a change, along with the data, if it has any interest, which is a structural change of how many lines of care are we inserting in the treatment? Ah, I have a sore throat, okay, I can't take care of, I don't know, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I'm laughing, I

I think we have a lot of technology today, a lot of computational capacity that should put us in several simultaneous care lines so that a given does not go unnoticed. There are incredible projects that happen here in the hospitals of Brazil, you know, found in the hospitals, I've never been here, found in a cancer hospital, in a lung, in a x-ray of low dosage. Look how interesting, it was not invested.

So, I don't want to complain, but just to make it so important, it's given with context, and I think these tools, these devices, these teams, even if it's a challenge, you'll have data that will need context. I think that's what you need to understand. When I started migrating my journey to learning management, I'm not going to say that I had to transform my mindset, because I always understood that what I learned as a doctor I should preserve and combine

to add the expertise of the other branches, for example, management. I think that's how I collaborate the most. A manager always asks me, when I started talking to managers, he always asked me about the data that becomes information that becomes decision making.

But we, as doctors, also have a principle, and I like the word "principle logic" for that. It's very interesting what we're talking about here, because we're living in a world that has a lot of technology, but what's missing in our world today is the principle logic. It's dealing with fundamental problems and using technology to solve them. You know? If I remember that James Cahn,

Luciano?

which indicator you will develop, which data will become the information. You have to ask yourself: what do I want to measure? And why do I want to measure? If we started with that, if we started to understand what is important to be measured, the technology is currently available. It is so that, for example, Google makes a lot of money, it is so that Facebook makes a lot of money back there. They took a lot of data from all of us and, well, these data can be sold, I can take advantage of CEP

This person has several people interested in crossing the CEP with the age. We need to start there, asking the right question. And when I understand that in the health system I already have this data being produced, and I have it, what is left in the health system? Not only here, but in the whole world. There is a cost left, there is no money left.

We are talking about a contribution margin in Brazil of 6%. The contribution margin of a hospital today, on average, is 6% to 8%. It's very bad. The technology areas work with 30% more contribution. So what's left over in health is cost, it's not money that's left over.

If there is a cost left, let's tackle it first. For example, if I can, with a project from Hospital at Home, reduce 30% of my cost, because how much does it cost to have a service of care working 24/7, with high-level professionals, 24/7 there, fixed, the others inside the ward? How much does it cost to have an intensive care unit with 15 beds, with 20 beds, working 24/7? How much does a surgery room cost inside the hospital?

If I can do something back there, before the patient gets to the hospital, that's when I have to start working. And in the logic principle, the idea is: what do I already do without technology and add technology to it? What does the doctor already do? He has his private patient and he says: the private patient calls him, I send a message, he says: "Doctor, I have pressure this way, doctor, I'm missing breath." The doctor collects some data,

He asks about the pressure, the respiratory frequency, the medication the patient is taking, and he makes some decisions. "Look, do this: you take one more pill than you are taking, and you call me from two o'clock." Now I have to transform this into a technology framework. For example, as people do in Boston. If there are data capture systems that give me respiratory frequency, human congestion signals,

and I indicate that this patient is entering cardiac insufficiency, before he comes to the hospital, I have a line of care that he can do a viro-oral diuretic at home and even have intravenous diuretic or parenteral at home, by lines of care there. Only after these lines fail, but they are being monitored, is that the patient will use this more expensive network, which is the hospital network.

So, we have to talk about technology, we have to talk about principles, when you talk about data to transform information, and as it was very important to talk about here, we are talking about interoperability, and we have to talk about anonymization. If we don't talk about these four items, for example, I won't be able to, I'll fail, I'll even have the technology, but I'll fail in compliance, etc.

I have to put everything in and there must be other N concepts that you can bring, but we have to start from the principles, then I take the data, transform it into information and transform it into decision making.

Perfect. Do you believe that we've already spent an hour here talking? We've already planned, I don't know, 15 questions, but it's a very rich thing, because it went by very quickly. We have to make a version 2 of this panel here to evolve and get to the other 12 questions. It was very good to see a vision of a leader laboratory, which brought the other laboratory to talk too.

Thank you.

Wait a minute, guys.

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Guys, this panel is so rich, right? I think this opens up exactly what I had said at the beginning. Here we have the reference and... The microphone is full of battery, because this one is over. And that's why we're here. If it's not us who start thinking about it, who will be?

because there are many interests, but those who can make this level of discussion, we are here, we are few. So I wanted to invite to this second part of the panel, Shao, he is a professor, he is a father of telemedicine, who is here, it is an honor to have him here.

And André, who is from Fleury, I always say that I always loved it there in Reckon Med, we always did this, we would gather with Einstein, Taza with Fleury, I think this is the rich part of being able to be in a

top here of innovation, reunites people regardless of the institutional issue, because here we are talking within the space of Innova HC, in a way thinking really about the importance of health in Brazil. Thank you.

Actually, for the beginning of the conversation, I would like you to introduce yourselves, saying more or less what you do, how you got to the moment you are in. And then,

I will need, we will do it in a way that is a little dynamic, a second part of the panel, where everyone will participate, but Bruno knows very well that I have the syndrome of Ana Paula Padrão,

to participate for everyone, right? When the time comes, so we can run through several themes, we will do a dynamic here with everyone participating, but running very fast through several themes and we will have time for that, so we can run through several themes, okay?

and I'm a first generation doctor and I was part of a select audience Gustavo curso here in the HC also maybe you don't know here

When we started the family medicine, we needed to think about taking care of the continued care from the beginning. It doesn't work if you don't have primary care, it only works if you have secondary and tertiary care. It doesn't work by itself, it's just a cost, it's just a problem. So, in 2000 until today, it promoted a great change in Brazil. Many of us became managers, became health secretaries, became managers within the health department.

And I was one of them. So I ended up becoming a director of a small UNIMED, then I participated in the UNIMED Santarinha, UNIMED Paraná and UNIMED Brasil. UNIMED Brasil created groups to encourage journeys, groups to encourage assistance paths, people who already thought about it.

I still think about it, I think a lot, but I have difficulty getting to the MS, to get to the structure. And then I became a provider. I work for Amparo, I work for Davita and now I've been working for the Feuí group for eight years.

and in the service of primary care but again you repeat the same story that I already have it doesn't exist alone, right? You can have a good family doctor take care of him until a point when you get along with specialists you don't know anything that happened to the specialist today you are at this moment creating these journeys, creating data journeys, right? and I think I

as our colleague here from DASA has already presented, the structured data of the laboratories in Brazil are the best data. I think the best data in Brazil is still sinister. Sinister is a good data, a very valuable data, a data that we know who did what, what procedures, where, when,

And the second big data, structured data, is 10 years old. Unfortunately, it's not ready yet. There are still a lot of people who want to improve the other types of data. But there is data from occupational, data from wearables, and several other data that can also compose these journals. And we are right now, in the Flurry group, creating these

these paths of locating people at risk and taking care of them, transforming data into care. For those who don't know me, my name is Shao, I am a doctor graduated from a university and I started working with telemedicine in 1997 when the discipline of telemedicine was created. Today I am the head of the discipline, I am part of the USP research group at CNPq and I have actions

at the Federal Medical Council and at the Regional Medical Council of the State of São Paulo. In these last months I changed my title, so the academy was in the second level, the first level, as I have several lines of action, I'm working in an area called strategic ecosystem curation, because the biggest problem is when you look at things individually, you don't know how to connect

a network of discharging processes. So I have worked in this area and the last work I have done was with the other. We launched during the hospitalization the first 100% national digital health accreditation manual and among them we have the relative part, the PDI,

innovations, among others, to concatenate the ecosystem, because if not, what happens? All things are individualized, so you don't create the chain of deflection. So today I work a lot in this area, I have grown my education to longevity, I also work, and I don't call it prevention, because in my area,

In medicine, when it was graduation, prevention was for those who were not good doctors. Then they would do the prevention by giving instructions. Today I work with the professionalization of the health and well-being of the lifestyle. This is a point that I create names. Last time I was at ICOS, on Monday, and they were discussing interoperability. I said: "I don't talk about interoperability."

I'm talking about clinical portability with integrated care. So, many times you have to get out of the line of simply using the technological point and say what is the result, what is the benefit. So, I have worked on this line as an induction so that the ecosystems begin to connect. And what I think

The most important tool today that I have available is accreditation as an inductor of organizational development. Thank you. Well, I brought it here, right, that the health system was built to treat the disease and not to promote health, right? So we are living this moment and

what we have of more concrete data that no IA will be able to change. We will all be 100% sure that we will have mortality. So, this is a fact. And then, within this concept here, that we will even die, because we will, unfortunately I have to say this to everyone,

What are we going to do with this? Promote health, treat disease? So this scenario that we are living now is a transition phase. I no longer see that we are in that model that we only had a hospital to treat. Everyone talks about health and one thing that, Luciano, I have changed a little in the way of talking about putting the patient in the center of the journey.

the patient doesn't have to be in the center, he has to walk together, right? Because, like, we don't have to be all around the patient, patient, passive, sit down and everyone serve him. He is the greatest actor in this process, he has to walk together. So,

I think we are in the moment of this transition phase. So my question to you, Chao, for example, I would like you to bring a little bit of your vision of connected city, connected health, architecture designed for the health of the homeless. We need to really have

the patient going to the doctor or the telemedicine booths. So, bring a little bit of what you already live, that we are in a transition phase, it already exists here in Brazil, for many people who don't even know about it, there is already a lot going on. So I wanted you to bring a little bit about your experience, and then I'll ask you the question, André. Well, let me provoke a little. First, I'm a doctor.

but I don't take care of patients and not only patients. The patient is very passive. Then the person asks me: "Why do you take care of people in the timeline who may be in a certain sick phase and may be defenseless being a patient?" So, it goes into that line, I work with participants. So, that's a first point. What is digital health for? To generate engagement.

Without engagement it doesn't work. You see that I change. It's not teleconsultation, teleinterconsultation. I work with engagement. The second point: what is the point of treating a burning house if the hand is on fire? So, the place where it is and the way of life is the determinant of its occurrence. So, yes, the housing, the houses. The houses must be well planned.

And the houses need to be intelligently healthy. And I'm not in favor of intelligent, I mean, entirely digital. In fact, I hate it. Why? The elderly does not like 100% digital. He likes it digitally to the point that he has insecurity. This is what I call the architecture of this process. Prevention of diseases. So I'm putting another one. You don't think that health professionals

is that it does health. No, it's a teleconsulting of architecture. It's one of the most important things. the reduction of the danger inside the house, avoiding accidents. So, I would already say to the health operators: "Have you ever thought about giving a teleconsulting of architecture?" They would say: "What?" "Signalization", for example, with fluorescent tape.

Have you ever thought about vertical iconography and horizontal iconography? No? So you are doing the wrong thing. The most important thing about health is not just the doctor, it is the multi-professional. And the most important thing is the health concert. They asked me, for the elderly, is the coordination with the nurse? No. So who would you put there? Maybe a gynecologist.

If you don't have gerontology, maybe you'll attend a social one. Because the person is healthy, but the person has to understand the architecture of health. So I'm not very much in favor of conventional. I'm in favor of reinventing the chain process. So there comes a point. Sorry to say something you won't like. The word longevity. In 20 years, it will be a parable. Imagine that in 20 years, we will have so many

old people and so few young people, you are living too much. But in that sense, not longevity, but longevity of the entire. And then in the hospital you use the word longevity. So I am in favor of creating the health and well-being of this life, to create something called participatory maturity.

we are one more future and it cannot be old, it must be necessarily intergenerational, otherwise you have a social rupture and this is the model that I am creating in Santos. I have a great project called Santos Jovem Doutor, I work precisely with teenagers and I will work now integrating with the elderly to create

And then the BSS could help. Intergenerational entrepreneurship. And I was commenting a little while ago, what is the biggest cause of dementia? Lack of dissonance. More than lack of dissonance, lack of purpose. So this is a construction. So you see that I'm not talking about disease prevention and not only health promotion, I'm talking about lifestyle.

The lifestyle generates health promotion and pain prevention consequences. So that's why I used the word lifestyle. And finally, the best prevention starts with children, and especially school children. Because it will become an adult who will internalize a habit and this child will take it home and will change the behavior at home because it will say: "I learned at school".

This other failure of primary care, you see that I have a question about primary care, is that it can't get into education. In Santos, I managed to unite, I've been working for 12 years, we did the 12th edition, we have 650 students a year, 40 teachers, and then I work in a thing called citizen attitude, I teach prevention.

I make them create, understand and they interfere in this process. And I managed to bring health together with education. That's what's missing in Brazil. I'm working with Mani Colé, which is in the Rio Madeira area, and I'm teaching the environment, because it's another fundamental thing. It's not enough the house, but you need to define the environment. So, this is the way I see it. Digital health has to be broader.

Thank you. We are here with entrepreneurs, investors, we are talking about business, and there is no way for it to work if there is no money in the game.

I wanted to ask you, André, how Fleury went around, he left his clinical analysis laboratory, then you will see the slogan, "We take care of you, you trust." He doesn't say anything about

disease exams that with the exams they do so how did you transform all that classic fleury that everyone thought about the health laboratory today in this context and

a book was written now about how it started in 1926, the average age of the Brazilian is 37 years old. So the day it was first opened, the first unit of the Florita, there was

a report of an old woman who had died by run over by a bus that entered her house, a ungoverned bus, and the old woman was 40 years old. So, the Florito is part of this longevity, of expanding this age, we walk with it.

But what Charles said is true, it is no use reaching the 80 years of being an immovable, without being able to climb a ladder, without being able to be active, so it is not just living more that worries us, it is to live well, to be active, working, work is not the fruit of a good life, it is not a punishment, so we want people to be able to work in a dignified way.

Now, going to your question, I think we join the previous question, the transition, going to your question, how do we transform care into money? Primary care is one of the points where Flori is investing in it.

and it is not easy, experimental health is poorly invested, it is poorly valued, we have grown in fee-for-service, we have grown in volume, the Fiori group, like other laboratory groups in Brazil, are stronger than the clinics themselves, and they have grown in this model.

But what brought us these 100 years is that it will not take us anymore 100 years, that's obvious. Everyone has this very clear. We need to explore new models of a worth-of-time capitalism. So the first thing is that we seek pertinence. We don't want to make money where there is no pertinence. We don't want to make money in waste. We have to reduce it more and more. That this is not good. It's not good for anyone.

And primary care is a lever for that. I want care and who needs to be cared for. When we arrived, we started to implement the primary care services, the longitudinal care, the continuous care, and we realized that this sector was the one that brought the most new people to the Flori group. It had never entered a company.

To answer your question, how do we transform this into this capitalist world, how do we make money with it? I'll tell you a little bit about what is digital health within the Flori group. We have two main areas, one is digital PA, which is a punctual care,

the time you enter in 15 minutes you are talking to the doctor, there may be a lot to solve, help a lot, but he is punctual, it's like a emergency plan, I go there, I understand, bye, generates data, generates comfort, I have a sore throat, will I go to the hospital or not? Or I have a sore leg, maybe I can go to the doctor. So he has this factor of solving, right?

but it does not generate continued care, it stopped there. This was the gift that COVID gave us. It released CFM, CFM released telemedicine, and we took this important step: having a digital emergency plan. Okay, primary care is not just that. Primary care is to take this care and now transform it into continuous care, and in the engagement that Chau said.

It's no use looking at the person once and then saying goodbye. That's nothing. So, we created, in parallel, we created hybrid ambulatories that can be inside the company. So, for example, we have an Embraer, an Ateu, a Volkswagen, we are there taking care of people inside.

but also taking care of him when he's not there, because people travel, taking care of the family, taking care of him in the continuity, or taking care of him when he's away, which is the main moment to take care of a person when he's away. And we started to understand

that this care is continued and then we regulate how many exams these people do. I want them to do fewer exams because in the end what do I deliver? I deliver a control of this

I'm not delivering to the company the growing sinister, I bring a control of absenteeism. These are two big shortcuts that we give to the company. So how did we capitalize on continued care? Delivering something that is now hurting the company.

and in the last panel they said that we have a huge amount of data, right? I think there is no more missing data, there are no more problems with data, there is a big database that is data of the disease, there is a big database that is data of the exam, there is a huge database that is data of occupational health, there are huge databases of the AI Health,

of the data, just the cell phone is already, if we interrupt, if we are walking, a series of data. How do I transform this, this amount of data to solve the problem of the company? Because when we look at who is, who encourages financially

the money circuit within health and that will benefit health. The person himself cannot have this vision.

They don't invest in their health, they invest in the gym, but they can't invest in their continuous care. It's very difficult for the person to buy products for themselves. So today, who invests in preventive health, in promotion and prevention, the term we are going to use, is either the government or the companies.

because the company wants to see the person working, it wants to spend less on the industry, it wants to take care of it, so that it can be transformed. The operators and insurers themselves, as mentioned, have difficulty investing in the person because in two years there will be a turnover, the wallets are changing. So, in summary, how do we transform a continuous care into ROI? How do we show it?

the continued care lowers the necessary interventions, it lowers the absenteeism, people can work better and now with this natural attention to mental health, it can control mental health order problems that are

much more complex to solve than just exams, and certainly transcends only the normal health that the doctor was created. It has to be multifactorial. So that's where we're going. Wonderful, so it's like this:

I think that these transformations that are happening, when we imagine that Fleury, who was worth going there for snacks and just doing the exam, was going to think about doing something so that people don't have to do so many exams.

I'm going to move on now to this part a little more dynamic, which is the part that I think is the most complicated part, right? Of continuous care, of workables, data and everything else. It's the rights and ethics. So, I'm going to give you two minutes, there are many, many small themes, and I would like you so much

bring your opinion or someone from the audience, but I'll give you two minutes. Then the alarm will ring and we'll have to stop, so we can run it all. Girls, can you do it for me? Plan two minutes. I went to the timer because it will start the alarm and then we'll interrupt. First thing, the right not to be monitored.

can the operator offer discounts for those who accept monitoring? Can a company favor the hiring of some employee just because he accepts to participate in these programs? So I wanted to know here from your opinion, if you think this can happen. We have seen this in the pharma,

when you go to buy your medicine you sign up and give your your CPF and when you sign up there you are giving all the right to use your prescription your data to use and win the medicine no more than 100 reais it is 75 reais so you get a big discount of 20, 20, 30 percent every time you enter these pharmacy programs I think it is to turn data into money, right? It's a

It's a way to somehow value people who let their data transit. Anyone else? Will it happen that the operator gives a discount only if you participate in a health monitoring program? Just to say that no one can force anything.

especially now that we have the right to the patient. But you can make an incentive plan, one day I was thinking about a health trip. Do you know that here in Hong Kong there are a lot of walkways? Then you see that people walk and go and feed with a card? Do you know what it is for?

Because if you read that part, it goes in the card and a mortgage comes in, because the government, which is part of the principle, is letting you be sedentary, you get a mortgage and you will have a discount. So you have to create a plan of health insurance and not force it. But I'll say something else. Who wants to keep drinking alcohol?

after having a cirrhosis, it's no use saying that health is a right and duty of the State. No, you have to take care of yourself. But you can't interfere with that today. You have to interfere with it when you're a child. So I think that's one point, but we'll have 20 years, at least, of a discussion about what is yes and what is not, but then you have to use the marketing of health media to do this process.

Wonderful! Let's go to the next one, you can change it, we managed to do it in two minutes. Who will be the true owner of the data? Who will LGPD secure the data for? Who will profit from this data? Will the patient become the owner, is he really the owner of the data itself? Well, for me, LGPD will disappear.

The data is from society. Period. LGPD does not work for the disease of compulsive notification, because it is a social strategy. What exists is to have a level of knowing how to use correctly and not in an abusive way. We are in a transition. LGPD is not the supreme law, it is an infraday.

And this infralaw is applicable when there is no other preceding law. So, the transparency law, the law of notification as a result of disease, is a law above the LGTB. Today everyone is scared of it. So, just to repeat, blood donation, which will become a product, which is the blood. As long as it is identifiable, you have to respect it.

but then it becomes a social product. So, these data that I saw, that are being made, for me, in 20 years, 30 years, are the heritage of society, regulated by standards that guarantee the correct use. So, I don't think the LGPD will last that long. And there are several ways for you to surpass the LGPD.

So, what is it? Discount? So, put here that you agree, you have already authorized. So, LGPD also doesn't work, there are other mechanisms. When we went to look for a certification for primary care, and England had a very large program, the largest program, the one that certified the primary care units the most, the first one, which is English,

was the rigor with the care of the data of the person. The person felt that he was talking to his doctor and died there. She didn't want anything to leak.

So, care, care in some environments is what generates wealth. Fleury has this very strong, care with data, if the data is based on Fleury, the stock of Fleury falls, the company dies. So, in some aspects I agree with Ricochá, but there is this other side, the security of your data,

What will happen, I think, yes, there will be the concept of health protection, I mean, I'm transmitting this data because I'm taking care of you.

I'm transmitting your data because society needs to take care of those who have this kind of disease. That's clear. And another event that will happen is that you will be able to better manage your data. The brochure is not with you. If there is any brochure on your phone today, no one has it. If you have data from the exam, from the data, the data from the exam, it must be on your phone. Apart from that, what your doctor wrote about you, you don't have. I think this is going to start happening.

You leave the consultation with what the doctor wrote about you. And then you do what you want with your data, because the data is from the patient and the doctor. And I think this can be a great way for you to manage it. If you go to another doctor and say: "Look, here's what the other doctor wrote about me." So, return the data to the owner. I'll say something. Interoperability, in principle, will already be shocked against LGPD.

So that's it, governance and correct use. But clinical interoperability and portability already confronts the clinical reality. This thing about the data from the clinic, for dogs it already has. It already has. For machines, for machines it has. For cars. Right to biological forgetting. Then we already know everything about ourselves.

we can have the right to say one day: delete all this, she knows that I, I don't know, I smoked for so long, it was heavy, I don't know how much, so the patient will have the right to delete their own data?

but it's more difficult, right? Because if the data looks for the truth, the drop out, take my data out, it will be more and more difficult. It's one of the terms that LGPD says when I want to go out, I want to delete my data, but in practice it doesn't happen in such a clear way. I think that

artificial intelligence will have its limits, this is one thing, it will not be able to fuse the way it is fusing, it will not be able to hallucinate over real things, but the data about what you were in society, everything you, of free will, put in the LinkedIn, took a picture and put it there and it was open, how are you going to get it out? I think it will be impossible.

I think it will be something like this: you have the right, but you will never do it. Because otherwise you will be excluded from society as a whole. You want to be excluded from the financial system? You will not do any more purchase, you will not have any more bank account, you will not have any more credit, you will not have anything else. I think there will be the right, but you will have to use it with prudence. I personally think that all the integration of data portability

and puts the person in a life model. So, again, governance. You are traceable in your telephone call, in your bank account, because the Supreme Federal Court can authorize the break of secrecy for so many years. But it's not anyone who can, there are only rules. But you can't say: "Drop it." So there are limits. So you can say: "Drop it for use."

but the judicial system can't say, for the purpose of investigation, no, because it can say, why are you here to erase? So, it enters a legal polemic, so you can say, you can erase it as long as you go through these processes saying that there is no legal problem involved so that it can be excluded from the social network. It's that things, America integrates

You can even talk about social networks, but if you get your data out, for example, my digital data, if you get all your vaccination data out, I think it's hell. The alarm rang, Alice, but I just did it hidden, without that noise.

risk of hyper prevention. So, it was spoken a little, right? What to do with all the data, the risk probabilities? Will we be increasing health or anxiety? I'll even share a little something very quickly with you. Before the pandemic I had a terrible cough and then, well, I went there to do a tumor in the lung, a little nodule appeared in the lung.

my God I have a business here I started I even went to oncologist thinking about taking part of my lung because the tire said there was a small possibility of maybe this little tumor in 10 years to become a cancer we are living health or anxiety

I think information without context generates anxiety. It has already been proven that Apple Watch, in its ECG record, generates things much worse for a general population than benefits. Because people have anxiety because they have arrhythmia. And, however, we have physiological compensation.

So, you have to have a specific point. So, I think technology is too much, too much information without context generates anxiety. And A, without context, also generates anxiety. I'll just say one thing that was in the class that I gave at IMACAPA. They told me: "Professor, what do you think of IA?" Well, I think it's good, but I think grammar will never understand poetry.

and A is grammar and we went from being poetry to being the same. I'll throw this to another context, which is what we do with the databases we have today from companies. Companies want us to take better care of the populations, they want us to think about how the population is, instead of thinking about the person, think about the population.

who has a lot of data about them, who did mammography, who didn't, who did cholesterol, who did glycology, before we even enter the company, we already know a lot about this company. It's the same thing, if I don't ask the question before I start looking at the data, I drown in the data lake. So the question is: what do I want?

with this company. The big problem has been column problems. So let's look for those who have column problems. We ask the question before looking at the data. For us to look at the data, they give the answer to what we are already looking for. If I look at it data by data, I will start to get scared with rare diseases, with this and that, a lot of things that will lead us to want to make a lobotomy in the lung. And this populationally. So, the expertise

The expertise of asking the right question will make the data work. Wonderful! Medicine of probability, that story of Angelina Jolie, there are already people who do preventive mastectomy just because they are at risk of having cancer. Would you like to have a crystal ball to see all these probabilities?

I wouldn't like it, my wife particularly loves to go to the card market, right? And then there's good and bad things. I don't like it, I don't look for it. And one thing I think is important is what we think we attract. We think about the negative thing, the probability,

talking about science, right? Talking about law of attraction. We create our universe, the force we put in it is the energy we put in it, right? So that's why I would say no.

I wanted to marry question 4, which talked about anxiety, I think it creates a very big responsibility in the formation of new medical professionals. Because here we are talking about a top school, the best school in Latin America, one of the best in the world, but there are many, many colleges training doctors that when

takes an exam with an inadequate context, or without the appropriate training to insert the patient into the context, can direct to an intervention that would not be adequate. So, adding up to four with five, for the patient it can generate anxiety, but it generates an additional workload for medical teams.

I learned something not being a doctor, and I love to use these phrases, and a doctor is to correct, but genetics is more destiny.

And what you do with your life, I use the term that epigenetics is a light switch. You have the light there, it's off. Depending on how you live, if you activate the switch, you'll turn on the light. So I would like to have the ball, no, and I believe that it is not because I did the exam that I will die, I have a disease.

Well, I have to give you a quick thought, just because BRCA1 or 2 carries 30 to 40% chance of having cancer and after 50 years of ovarian cancer, which is a difficult detection cancer. So in this case, in particular, prevention ends up being necessary and the genetic test induces real protection, in this case.

This is a question... Turn off the timer. Now it's your turn.

This is a question we ask before the genetic test. You ask the patient how far they want to know. Because genetic tests are probabilistic, they are not deterministic. And there are genetic types, a series of questions.

And if you are doing a genetic test for some questions, the geneticist, the doctor, even the general doctor asks: "How far do you want to know?" Because this exam can show you this, this, this.

and before you read the test you say, although we have to understand that the probability is very high, we even make cards, look, this is a card of a thousand women, here are five women who will give positive results, but only one will have cancer, you have to show visually for people to understand the probability, to understand that it is a test, he is finding more susceptible people, it doesn't mean that you will

People try to understand a little bit of the number to be able to interpret these tests. It's getting more and more accurate. There's a test coming out of the cartomante, right? When the genetic tests started, they remembered cartomante, maybe you this, that, to go to a... Mainly the genetic tests are becoming very assertive and it is asked to the person before.

Well, I think it's very complex. First, because there are several factors involved. Second, it's a lot of things. I think you have to analyze according to the emotional archetype of the person. And many times you say an information, you have already destroyed the person's life. Only because you know that you are going to destroy life. I think it's something complex. By law, you will have to say that you have the right.

is a citizen, has information, but if it should or should not, I think that is something more complex, you will have to do an analysis, it is not just a doctor, it will have to have something to do with the family and this process, because it is something complex, with more serious information or not. For example, degenerative disease, progressive, right? So I think it's a lot of saying yes or no, just by law, I think

but if it will be used, I think it has to be discussed. There's a lot, right? When we have the conflicts of IA answers, the sensors are different and everything, who will regulate it?

How can we audit all the black boxes? Today we even have a test with Garmin, Fitbit, Apple Watch, how many steps, each one takes a different step. Will it be possible to audit all and so many new technologies that are emerging? How to audit this? How can we regulate this?

I think that in this case it will depend on the type of device we are talking about. If we are talking about a watch, a watch for sports, for monitoring, sold by a brand that the end consumer goes there and buys, it's the same as different types of software, but you will never be able to normalize it. Maybe if you talk about a medical device,

inside the laboratory, inside the hospital, maybe with a law, a regulation, you will be able to have a hardware technology base that will force what is inside a health institution to use a standard. But I think that outside of that, talking about Nike, Apple, Garmin, Polar, it's very difficult.

Who will admit that your step is different from the other? I'm going to break here a little bit. I think there could be a service like Connect your cell phone in that application using Google.

there should be a service that certifies that all your cell phone data will be validated by an entity that will have a stamp. And when you connect to the Google of Health, which is a certified, authorized, structured way, then your data is used in a way that is auditable. Besides that, any data that today has a lot of place. So I think at some point someone will have to create an entity, a country, a stamp that validates any data that enters, and we all here created a vestibule device.

We have a very limited time.

There is another concept of monitoring models, which is monitoring the models, because the same model does not have the same performance with the same database and go through fairness. Then we can have models suitable for a context.

I think it's a little bit in this other question, will it be necessary to create another auditorium in addition to Anvisa? I think it's more or less that. And about what we had talked about Wellness, people went to Wellness to dispense Anvisa.

Who will audit? I think Bruno brought it here a little bit. Maybe we will enter a future close to needing an organization that can start trying to regulate this. At the event this year at Stanford, the Wellness, it was the event where they left the discussion of pure wellness, they put it on a table

or a ring, all these vestibular rings and devices to discuss with some medical entities. And it was kind of a more acid discussion where they discussed that either wellness moves to science or this data cannot be used anymore as it is being done today, because it is already a data that can help health a lot and is not considered as an auditable data because it is wellness.

So this conversation happened, they did not come to the conclusion of having a new Anvisa or a new FDA, but rather specialize these bodies in understanding how to evaluate this type of device in a more responsible way. Just to complement, within the plant there are already diagnostic support services that begin to be audited differently, the SAVES service, the diagnostic support service,

is not seen in the same way as the ICI and CFM look at the Protoare. There is already a subdivision to understand artificial intelligence helping the doctor inside the Protoare. It's also not clear, but we know it won't be the same way. I'm going to skip to another one.

Well, let's go on because we're going back to this topic. Who will be responsible for the inaction? That is, the alert was set, it says that it is there with high pressure, who will be responsible? Then the cell phone signal is over and then it was not sent, or then the person who had to see there, to follow this, did not follow? Who is the doctor here?

Which doctor wants to know the whole time, every time the patient's pressure changes, the blood pressure rises, or anything? I don't think any doctor wants to know that. So who will be responsible for that? I think you will have a legal person, not a physical person, who will be responsible for managing this capture and filtering.

And the filtering sends the most significant things. So you will see with NAPO and IA. This is a fact. So you will have auditing and more relevant and then send the process to the professional. I will not even say only doctor. It's like a copier. You will catch and you will see. And the second, not always an emergency change. If it was an emergency, it means that it is already in the ICU, that it is already hospitalized. So you have to be very careful

So,

your aritemia, you activate the prototype, you've seen it, it's nothing, it's just your... it's the ART that's not calibrated. My intervention goes in line with what Dr. Chau said, it goes a lot with what will be hired by the user. So, there will be a user who wants this data to be treated by an organization, it falls to a doctor or a medical board that already activates it in some way, and then there will be a user who says: "No, this will be with me, it's my responsibility."

And then it falls into the individual's compu, like today, a simple diabetes test, the person can see that her diabetes is bursting, she asks for a milkshake in a second. To conclude, I think there is a question that we talked about on the other panel, sometimes to take advantage of the experience of other sectors. I was head of architecture of a credit card processor.

and one of the products I worked with was the lunch box. And there, a crisis only happened if a meal was not approved during lunch.

breakfast and lunch boxes. So you categorize the management of events that happen to know what is critical and what is not, is crucial. And then, within that, health has to learn a lot, maybe inspiring itself in other industries that work with critical mission, aviation, cards, to start structuring what is critical mission within health, which deserves more or less directional attention. Perfect.

New role of the doctor, these IASCs are clinical decision support. I will tell you a case here that was a person I know, she was working in a health care center, there they have the board spoken, right? And they have clinical decision support and they have a goal to serve as many patients per hour

And so, there was a lady who fell, hit her head, she wanted to ask for a tomography. The clinical decision support was written that she had to ask for an X-ray. She can't ask for the tomography and to be able to ask, she has to ask for authorization, which will waste time, which will lose her productivity, and I don't know what.

and this clinical decision support is a health vertical she's doing what right so this is where we put it and I wanted to know how we're going to be able to deal with it especially with this new generation of many doctors who are forming that maybe don't have

a training even to understand that it was important to ask for a tomography for this patient. One of the concepts that, when, more or less three years ago, the generative modality of social intelligence took over the body for all of us, this has been working for 20 years in several industries, for example, the retail industry used social intelligence for 10 years to sell clothes.

but three years ago it changed for us in several forms of consumption, including health consumption. One of the concepts that is more crystallized for me, I see it in the United States, which is quite different already in Stanford, California, everything, also in New York, is the concept of the human in the loop. Always the human being will have to give

Acceptance or Responsibility. Responsibility is a very important issue because we have a lot of technology and the regulator will dictate the speed at which we incorporate this technology in our daily lives. For example, four years ago we already had 5G technology to operate an individual from the other side of the planet in real time.

The army started working with this. They started working with robotic surgery and established a limit of up to 200 milliseconds of delay. Today, we have already done surgery here in Brazil. The Júlio Hospital did a surgery with a patient in Rio Grande do Sul and the time was 36 milliseconds.

and the law was 7:20 seconds well below the line that the army put so we already have technology only the regulatory makes certain questions if you were operated by a doctor in Brazil

and this doctor is in the field, who will be responsible? And today there is a new concept that I call teleproctoring. The individual operates the robot together with the proctor, and the proctor has the right to stop the command. For example, if I am the proctor of a patient who is being operated in a small center in a city in the countryside, the teleproctor has the right to stop the command of the operator because he takes responsibility. See in which regulatory field we are going.

Recently we had in Brazil a girl who killed a child because she said that Ayá told her to inject adrenaline into her life. So there will always be a regulatory, CFM hit this 2454 right now. This is an interesting question. Rafa wants to speak very quickly. Ten seconds here, I'm not very succinct, but there are all these issues that I don't believe in education, I think we have to teach

In the past, it was an HIV test, where the doctor had to know the predictive value to see the risk and see if it has to be repeated. Now he has to understand the predictive models to see how much he has to relieve or catch. And within that, I believe a lot in the confidence as being the engine of everything we are producing.

and I think regulation is very important, but I don't think it will be able to be in the same compass. And within that, I really like Bruno's line of self-regulation. So, the seals for us to bring more confidence. I think regulation is very important, but self-regulation has a fundamental role. Perfect. The tic tac is going.

The patient's new role: the patient will stop being passive and will be a health manager. Will health be more elitized or democratic with this? We have a huge effort to capture people with health issues and when we capture them, we talk about cigarettes, about alcohol, about physical exercise. This is boring for the group.

People don't want to be caught, people don't want to talk about sports or what motivates them to go to the gym. It's not usually medical reasons, it's other reasons. I think we have to learn more from the poetry of the chau than to stay with our arrogance of "I know what's good for your life". Because people's motivations are very different from medical motivations or from a company that is banking for you to leave your population healthier.

So people are already donors of their health, in fact they are the ones who make the decisions about what will happen to them. They have abysmal information, there is no lack of information for people, but there is a big gap between knowing and eating the milkshake. And this is much more in the field of poetry than in the field of Harrison,

um excelente hospital que a gente aprendeu medicina, não é? São coisas que transcendem a nossa expertise.

I think this is a very complex issue and here I will try to just pass a point of view that I think we have two extremes, one is us being as a very paternalistic society, right, always saying what an individual has to do and the other is us believing a lot in the individual, right, and in

self-taught of each one to learn and take care of themselves. But then we have a problem of inequality and having a society that has a very big discrepancy. So it's very complex and I just wanted to provoke here, I think there is this vision that is, maybe it serves for one, a stratum of society and for the other, maybe not.

New health indicator. Chakab currently serves for us to diagnose diseases. Will this change? Will it be worth the time of sleep, variability of heart rate, VO2 maximum, vitality, steps? What will be considered a health indicator? I like to talk about the context, we have the tendency to put it in the human-centric, right? Only the ecosystem has. If we don't integrate the data from the ecosystem,

You won't be able to talk about health. If I live in a health environment and live in a ventilation building, the question is not my health, but the indicator's health. How do you integrate all these ecosystems? How are we going to integrate nutrition? Everything we try to say. I think we're missing more ideas, or continuous care. But what about the person's environment? Where does she live? Where is she? I think that's it. How do we integrate this ecosystem?

I think that in line with what he said and what you said too, I'll bring a phrase from Antônio Aranha, "with many powers and many responsibilities".

So, what is considered health for a person who lives in a tent in a favela, full of mold, who does not eat properly, spends three hours to go back from work? Health for this person, sometimes it is to improve her food, sometimes to make her simply sleep. Now, for a more select audience, who has time, has resources, has access to the gym, good doctors,

Maravilha!

The risk of algorithmic explosion. Health indicators can be used as selection criteria, as we already talked a little bit back there. Who does not want to be monitored can mean that they do not want to produce evidence against themselves, as in the baphomet test.

If people who are only going to be monitored, are only those who want to produce good data, will there be bias in the interpretation of this data? Well, I think we have to review that resolution of the IA in medicine, which talks about biases, including algorithm biases, if it is low, medium, high risk, and especially this one that is exclusion, it is considered high risk.

I think algorithms will turn into medicine. There must be the clinical phases, then there must be pharmacovigilance, so there must be a IA surveillance. Today we think that algorithm is wrong. It is an entity as much as a substance that we ingest, but it is used for social purposes. And the other,

When you are using a large mass of data, the individual is little. And the other, when you train the algorithm, you must have anonymization. Then yes, LGPD works. So the person is not generating evidence against him. Because if your rule is anonymization, then there is no such thing.

because the person may be eating, that's another thing, but I think society will have to walk as an instrument, including the similarity of the pharmaceutical industry when you look at the algorithm. I had a friend, Gustavo Lantz, who was a doctor, who worked with the Agitina da Vita, he worked here in the Ivalo da Caceta, he was attending a patient and he said: "look, wait a minute,

You said you're not eating more fat, but I'm looking at the iFood and you asked for two pizzas. I looked here at the Waze and you're crossing the red light. So, these types of data that we are already creating, of course, pray that they are protected, but they say a lot about us, even health, much more than data like VA2.

Today they are not being used, but I think that within a great context of security and ethics, they can also compose. We are reaching the end here. The longevity paradox: what will be the future challenges for the life of the long-lived? So, are we ready to live in a society with a lot of old people?

There are many elderly people with Alzheimer's disease. What will it become? Longevity will have to extend productivity. In this 60-year-old, it will not exist. You will probably have people with 75 years productive. The other, then it comes to health and well-being, is the lifestyle. Reduce as much as possible the risk of dependence.

If this doesn't happen, it won't work. Because today, the model we have of considering ourselves as an active worker, who is young, won't be sustainable for society. And then, yes, we have to create a new sector. And the last thing, just to say, even in the health and well-being and lifestyle, we have to work with

the part of civil construction. So we have to work with several other sectors that today we are thinking that health is only health. No, health is a social ecosystem that makes things work, then the market of abrogation is much smaller. Just to complement Professor Schall,

-

This already has a projection of what the GDP will be like in society when it gets older than new. In Sweden, the biggest challenge of the public health system is the elderly who are being abandoned by their families and already begin to discuss what the role of loneliness is, how it generates more health problems than other problems. So the community agendas in Sweden are doing as if they were fans to pick up the elderly and take them to play, to chat, to do social activities.

I would say that we are not ready for this. It is a society that lives much more because the health system today is set up according to the health plan. You have a health plan that increases the price to 60, from 60 more you have an absurd price. If the person at 60 is still extremely productive, we should change the model. So we are not ready, the conversations are not happening where they have to be. I was in Geneva recently

a market in a sale just to discuss this kind of European Union theme, look at it, it's a

It's a very old continent and I think we're too far from solving that. Brazil has grown old without getting rich, so we're going to have this problem of the poorest elderly. I just wanted to tell you about a case that I found interesting, from One Medical. One Medical is a primary care network that was sold to Amazon for 3.9 billion dollars. It was one of the biggest purchases that happened two years ago in the United States.

And one of the programs they had to follow the elderly was similar to the community agent, which went to the markets with the elderly to read the labels, to help the elderly choose. And of course it wasn't just that, it was a social role to follow and avoid loneliness. We will have to have programs like this here in Brazil because we are not really prepared. Perfect.

Health or surveillance? Are we going to live in a totally monitored society? Are we going to live a George Orwell 1984? Are we going to live a Black Mirror? Will everything be seen? Will the big brother see everything?

This is the last question, to really polemicize, and so, if anyone wants to put their positions here, in fact, it's a little of what we've been bringing today in this meeting, is precisely to say: continuous care will happen, it's real, it's already happening,

But there's a lot of things that are not technology, that are not data, that are not the part of wearables that we have to think about. And it's a little bit thinking about that that we're gathered here.

And maybe we can continue this in terms of doing here, I don't know if within the BSS we will do it or not, but maybe a work group, who knows, bring an opportunity to take this to a level

governmental, because of all this, these were few questions. How many questions are there for us to be able to work before everyone starts collecting data and gets stressed out because of a data that appears? So I wanted to thank everyone here too much, I wanted to thank the contributions of all of you,

we don't have answers and then we could be in touch I'll pass the you passed if you wrote there we pass a contact there for those who want to continue to discuss the subject and suddenly we really have something to do and take it to the government level think about projects of law that regulate this all so much has to happen before we have this continuous care I think it's

Who wants to buy? Who doesn't want to buy? That's it. The elderly who doesn't see, doesn't use smart glasses, doesn't look, who will recognize and will do it vocally for him. Who buys? So I think technology will appear,

and it will not be universalized. It will have a growth, a group, and then you can have the government encouraging or helping. So the future will be the smart glasses, that's a fact.

Ecosystem is another fact. The monitoring of devices are the people who hire companies, so new entrepreneurs will emerge in the ecosystem, not the device, which will trace this whole process. So these will work as if it were not the hospital, but that hopefully with the health service. So I think it will bring so many opportunities

And this had to create the exponentiality, then you can offer this to the government, which enters as a public policy, as well as a vaccine. The first ones pay a lot, for example, for pneumonia to be prevalent, but the government already gives tetravalent and so on. So I think it will be more in this area and I think it's a great opportunity to invent.

I would like to thank you for the invitation, your questions are much more inspiring than our answers, and thank you for this beautiful event that you had here. Thank you very much. Thank you guys. But then we keep in touch here, because I think it was a very enlightening chat.

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Now the photo comes in. Look, I think you have to stay here, or not? In the room. In the room.

I can do a lot of things.

foreign