1. TeH,15/09/08 Telemedicine in low resource settings: templates and examples of proven practices Maria Zolfo

2. TeH, 15/09/08 Potential uses of telemedicine in developing world Educational purposes Asynchronous nature (self-study via the web) Interactive (videoconferencing) Clinical purposes For disasters relief Telemedicine for second opinions

3. TeH, 15/09/08 Potential uses of telemedicine in developing world Educational purposes Asynchronous nature (self-study via the web) Interactive (videoconferencing) Clinical purposes For disasters relief Telemedicine for second opinions

4. TeH, 15/09/08 Educational purposes Asynchronous education Self-study via the web: http://polhn.org/http://polhn.org/

5. TeH, 15/09/08 Educational purposes Interactive: videoconferencing RAFT

6. TeH, 15/09/08 Educational purposes Interactive: videoconferencing RAFT

7. TeH, 15/09/08 Potential uses of telemedicine in developing world Educational purposes Asynchronous nature (self-study via the web) Interactive (videoconferencing) Clinical purposes For disasters relief Telemedicine for second opinions

8. TeH, 15/09/08 Clinical purposes Disaster relief, e.g., Armenian earthquake in 1988 (satellite link called ‘space bridge’ between physicians in Armenia, States and Russia) Transmission of fax data and audio- and videoconferencing for teleconsultations

9. TeH, 15/09/08 Clinical purposes: second opinion-advice Partners Healthcare, Boston, USA Tripler Army Medical Center, Honolulu, USA iPath Association, Basel, Switzerland Swinfen Charitable Trust, Canterbury, UK Réseau Afrique Francophone de Télémédecine (RAFT), Geneva, Switzerland

10. TeH, 15/09/08 Partners Healthcare Referring sites Rovieng Health Centre, Cambodia Rattanikiri Hospital, Cambodia Expert sitesSihanouk Hospital, Phnom Penh; Harvard Medical School, Boston DescriptionEmail consultations for health workers in North Cambodia (2001, 2 nd site in 2003; email)

11. TeH, 15/09/08 Tripler Army Medical Center Referring sitesUS-associated Pacific islands Expert sitesTripler Army Medical Center, Hawaii DescriptionA web-based teleconsulting system is used by the main US Army hospital in Hawaii to support referrers in hospitals around the Pacific (1997, web)

12. TeH, 15/09/08 iPath Association Referring sites Several, e.g. Cambodia, Solomon Islands, Bangladesh; Ukrainian Swiss Perinatal Health Project Expert sitesMainly Swiss, European DescriptionThe iPath software was originally developed for telepathology case conferences; more recently the software is as well for general teleconsulting (2001, email and web)

13. TeH, 15/09/08 Swinfen Charitable Trust Referring sites Global (34 countries) Expert sitesGlobal 13 countries DescriptionEmail teleconsultation with specialist opinions from a small panel of volunteer consultants; the operation has now grown to service over 100 hospitals around the world, with a panel of more than 300 consultants (1999, email and web)

14. TeH, 15/09/08 Réseau Afrique Francophone de Télémédecine (RAFT) Referring sitesAfrica Expert sitesGeneva DescriptionCore activity is distance education via webcasting of interactive courses; some teleconsultation with specialists in Geneva (2001, web via satellite)

15. TeH, 15/09/08 Other telemedicine approaches, on HIV/AIDS care TeleconsultationsWarm line ATIC Case conferencesPharmAccess TwinningAmerican International Health Alliance Moi University Web-based collaborationsAIDSPortal Partners in Health Cell-Life

16. TeH, 15/09/08 Telemedicine ITM, Antwerp, Belgium SCART: Short Course on AntiRetroviral Therapy (since 2003) http://telemedicine.itg.be/ (email- and web-based consultions)

17. http://telemedicine.itg.be/

18. TeH, 15/09/08 Telemedicine interactive sites, 2007

19. TeH, 15/09/08 4 years evaluation (April 2003-March 2007, n: 642 referrals)

20. TeH, 15/09/08 End users' benefit

21. TeH, 15/09/08 Telemedicine website visits/year

22. TeH, 15/09/08 Forum members, 2007

23. TeH, 15/09/08 Utilization rate (second opinions) OperatorCases (n)Duration (years) Partners Healthcare9006 Tripler Army300010 iPath Associationc500*5 Swinfen Charitable Trust15009 RAFT20**5 *Telepathology conferences; **distance education

24. TeH, 15/09/08 Why isn’t demand escalating?

25. TeH, 15/09/08 Why isn’t demand escalating? Free telemedicine service not valued? Cultural problem? Inappropriate experts? Referrers too busy? Perceived loss of control?

26. TeH, 15/09/08 Swinfen referrals: loss of control?

27. TeH, 15/09/08 Why isn’t demand escalating? Free telemedicine service not valued? Cultural problem? Inappropriate experts? Referrers too busy? Perceived loss of control? Digital divide Computer literacy Intuitive/user friendly interphase

28. TeH, 15/09/08 Low-cost telemedicine in the developing world Feasible Clinically useful Sustainable Scaleable

29. TeH, 15/09/08 Way forward Development of intra-country networks: (1) demonstrably alter health outcomes; (2) can be shown to be cost-effective and sustainable; (3) will act as a model for other countries to copy. Successful implementation would result in one or more successful telemedicine that could be replicated widely. Wootton R. Telemedicine support for the developing world. J Telemed Telecare. 2008;14(3):109-14