Since 1988 the Federal Constitution of Brazil declared health care as a public right to be provided as a duty of the state¹. Thus the Unique Public System (“Sistema Único de Saúde-SUS”), Ministry of Health, a comprehensive health care system with full coverage, was created since then. But the private sector has nevertheless also been operating since 1960s but without any government regulation at all. It serves approximately twenty-five per cent of the Brazilian population (estimated at 180 million of people).

The National Supplementary Health Agency – NSHA (“Agência Nacional de Saúde Suplementar- ANS”) was created in 2000 and is in charge of regulating and assisting the private health plan organizations. The public sector has been structuring its information systems for almost 15 years, defining standard schemes, such as the National Health Card Project, in order to institute a national unique identifier health care and to construct a national repository of health records.

The lack of widely common information standards in the private sector, however, and the difficulties involved in the complex information interchange among private health plan organizations and health providers have caused NSHA to work out a proposal for a national standard for electronic form interchange proposal, based on XML technology, known as the supplementary health information interchange (TISS – “Troca de Informação em Saúde Suplementar”). The TISS project aims integrating healthcare information nationwide; therefore it was developed in accordance with the National Health Card Project, using the same unique identifiers and others standard sets proposed by the Ministry of Health, such as unique identifiers of providers.

NSHA has presented the TISS project successfully to all stakeholders and is going to introduce legislation to enforce the standards. There are more than two thousands private health plan organizations in the whole country and more than ten thousands hospitals and clinics. Private health practioners, including dentists, will also have to adopt the standard. As a matter of fact, the TISS project not only focuses on the patient billing but also on epidemiological information. And the TISS project is not only for health provider claims, but also to all kinds of events such as consultation and exams.