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World Health Organization (2010) “TELEMEDICINE Opportunities TELEMEDICINE Opportunities and developments in Member States Report on the second global survey on eHealth Global Observatory for eHealth series - Volume 2 2010 WHO Library Cataloguing-in-Publication Data Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth 2009. (Global Observatory for eHealth Series, 2) 1.Telemedicine. 2.Medical informatics. 3.Information technology. 4.Technology transfer. 5.Needs assessment. 6.Data collection. I.WHO Global Observatory for eHealth. ISBN 978 92 4 156414 4 (NLM classification: W 26.5) ISSN 2220-5462 © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Photo credits: FRONT COVER: Top: © WHO - Middle: © Swinfen Charitable Trust - Bottom: © iStockphoto | Page 4: © iStockphoto | Page 6 : Left: © iStockphoto - Centre: ©Dreamstime - Right: ©WHO | Page 8 : Left: ©Antoine Geissbuhler, RAFT - Centre: © iStockphoto - Right: © WHO | Page 12: Left: © Antoine Geissbuhler, RAFT - Centre: © iStockphoto - Right: © WHO | Page 16: © iStockphoto | Page 20: © iStockphoto | Page 28: Left: © Antoine Geissbuhler, RAFT - Centre: © iStockphoto - Right: © WHO | Page 36: Left: © Antoine Geissbuhler, RAFT - Centre: © iStockphoto - Right: © WHO | Page 46: © iStockphoto | Page 62: © Swinfen Charitable Trust | Page 80: Left: © iStockphoto - Centre: © iStockphoto - Right: © WHO Design: TELEMEDICINE Opportunities and developments in Member States Report on the second global survey on eHealth Global Observatory for eHealth series - Volume 2 2010 Acknowledgments This publication is part of a series of reports based on the second Global Observatory on eHealth (GOe) Survey. The preparation of this report would not have been possible without the input of hundreds of eHealth experts and the support of the numerous colleagues at the World Health Organization headquarters, regional, and country offices. Our sincere gratitude goes to over 800 eHealth experts in 114 countries worldwide who helped shape this report by sharing their knowledge through completing the survey. We are also indebted to an extensive network of eHealth professionals and WHO staff who assisted with the design and implementation of the survey. Names of contributors can be found at http://www.who.int/goe. Special thanks to the many authors and reviewers who contributed their time and ideas to this publication including: Kendall Ho, Jennifer Cordeiro, Ben Hoggan, Helen Novak Lauscher, Francisco Grajales, Lisa Oliveira, and Andrea Polonijo of the eHealth Strategy office, University of British Columbia, Canada. The text was reviewed by international telemedicine experts including Richard Wootton, Antoine Geissbuhler, and Najeeb Al-Shorbaji. Design and layout of this publication were managed by Messagio Studios and Jillian Reichenbach Ott. Editing was completed by Kai Lashley. Their efforts are appreciated. The global survey and this report were prepared and coordinated by the WHO Global Observatory ACKNOWLEDGMENTS for eHealth: Misha Kay, Jonathan Santos, and Marina Takane. 3 Contents Acknowledgments �������������������������������������������������������������������������������������������������3 Contents ��������������������������������������������������������������������������������������������������������������� 4 Executive summary ����������������������������������������������������������������������������������������������� 6 1. Introduction: Overview of telemedicine ������������������������������������������������������������� 8 1.1 What is telemedicine? ����������������������������������������������������������������������������������������������������8 1.2 Origins and history ��������������������������������������������������������������������������������������������������������9 1.3 Applications and services for diverse contexts ������������������������������������������������������������ 10 1.4 Potential barriers to telemedicine diffusion ����������������������������������������������������������������� 11 2. Telemedicine in developing countries: A review of the literature �����������������������12 2.1 Literature review methodology ����������������������������������������������������������������������������������� 12 2.1.1 Study inclusion criteria ���������������������������������������������������������������������������������������� 12 2.1.2 Study exclusion criteria ����������������������������������������������������������������������������������������13 2.1.3 Literature search strategy ������������������������������������������������������������������������������������13 2.1.4 Selection of studies ����������������������������������������������������������������������������������������������13 2.2 Telemedicine in developing countries: framing the survey findings ������������������������������13 2.2.1 Opportunities for developing countries ����������������������������������������������������������������13 CONTENTS CONTENTS 4 Telemedicine supports maternal and newborn health in Mongolia ����������������������������������� 16 2.2.2 Barriers to realizing the promise of telemedicine in developing countries ����������� 18 Breast cancer screening for rural Mexican residents ����������������������������������������������������������20 2.2.3 Legal and ethical considerations for telemedicine in developing countries ����������22 2.2.4 Implications for telemedicine development, implementation, evaluation, and sustainability ��������������������������������������������������������������������������������������������������������������� 23 2.2.5 Key lessons from the literature ���������������������������������������������������������������������������� 23 3. GOe Second Global Survey on eHealth ������������������������������������������������������������ 28 3.1 Survey implementation �����������������������������������������������������������������������������������������������29 3.1.1 Survey instrument �����������������������������������������������������������������������������������������������29 3.1.2 Survey development ������������������������������������������������������������������������������������������� 30 3.1.3 Data collector ������������������������������������������������������������������������������������������������������ 30 3.1.4 Launching the 2009 survey ��������������������������������������������������������������������������������� 31 3.1.5 Limitations ���������������������������������������������������������������������������������������������������������� 32 3.1.6 Data processing �������������������������������������������������������������������������������������������������� 33 4. Telemedicine results �����������������������������������������������������������������������������������������36 4.1 Current state of telemedicine services ������������������������������������������������������������������������ 36 4.1.1 Telemedicine services globally ���������������������������������������������������������������������������� 37 4.1.2 Telemedicine services by WHO region ���������������������������������������������������������������� 38 4.1.3 Telemedicine services by World Bank income group ��������������������������������������������40 4.1.4 Other telemedicine initiatives occurring around the world ���������������������������������� 43 Norway's teleECG initiative �����������������������������������������������������������������������������������������������46 4.1.5 Implications for telemedicine services ����������������������������������������������������������������� 49 4.2 Factors facilitating telemedicine development ������������������������������������������������������������ 50 4.2.1 Governance �������������������������������������������������������������������������������������������������������� 50 4.2.2 Policy and strategy ��������������������������������������������������������������������������������������������� 52 4.2.3 Scientific development ���������������������������������������������������������������������������������������
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