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Suggestion for Policy in Telemedicine

By Yudha Saputra | 17 Oct, 2016

Dear Colleagues,

Indonesia, as a developing country's, going to create it's first Telemedicine Guideline under the role of Indonesia Government. The finalization of the draft will be printed before new year eve.

Mostly, the current draft still focusing on early adoption of telemedicine technology: teleradiology, and tele-electrocardiology. The focuses rose due to the boarder area of our country that lack of specialists (i.e.) in field of surgery, OG (Obstetrics and Gynecology), and in general, the knowledge of the local healthcare practitioners to dealt with new cases in real-time.

Equipments and tools section, become necessary element to be listed as the main source of the guideline, as whole area of our country (including from rurals) will look up for the minimum technlogy that can fit with their low-cost clinic and public health center budget, and possibility to overcome both geographical challenges and network issues.

Shall any suggestion about policy, experiences, and any reference to enhance the quality of the guideline (specifically equipment and tools policy in implmenting early adoption of telemedicine, teleradiology and tele-electrocardiology) in LMICs or developing countries, would be very appreciated.

Thank you



Elaine Baker Replied at 11:45 AM, 20 Oct 2016

I am also interested in replies to this topic, because I have heard from an organisation that attempted to implement telemedicine in Tanzania that the problem is not the technology, it is the processes. I assume that we are talking about provider-to-provider telemedicine (i.e. not provider-to-client telemedicine which would require different types of guidelines). For example it is not enough that you have the hardware and connectivity for a less skilled provider to communicate with a higher skilled provider, what is also needed is the processes - ie who does the lower-skilled provider contact? How is this scheduled according to the higher-skilled providers' work schedules and consultations ? What are the incentives for higher-skilled providers to take part, and how is telemedicine built into their job responsibilities ? How can you ensure reliability, ie if one higher skilled provider is not available, there are processes for knowing who else to contact ?

Pratap Kumar Replied at 2:24 PM, 20 Oct 2016

A short answer to this is that we're still very much in the 'innovation phase' of telemedicine (in high and low-resource settings). There are a number of issues (both technological and non) that need to be addressed, and the answers are more likely to come from innovation, implementation and experimentation than through 'policy'. The questions you ask, Elaine, don't have any one answer (or clear winner) - and therefore don't need to be addressed at policy-level. These are questions that each implementation of telemedicine need to answer and this depends on the nature of the implementation - teleradiology, telepathology, teleconsultations for primary care versus secondary care, telemedicine for decision support versus care delivery, telemedicine for direct clinical care versus supportive services like rehabilitation, telemedicine for real-time decision making versus asynchronous telemedicine, etcetera, etcetera, etcetera.

@yudha: my two thoughts about telemedicine policy (as someone who is developing and implementing telemedicine solutions) are:
1. Health systems should try and support the implementation of telemedicine through incentives (e.g. dedicated bandwidth at low costs) that are technology agnostic (i.e. every telemedicine solution is likely to need good internet access).
2. Health systems in LMICs should ask for a cost-effectiveness study for any telemedicine implementation. Many technologies used in high-income countries (and often implemented as CSR projects in LMICs) are very expensive, and every country should be able to decide if a particular technology (in both implementation and operational terms) is sustainable in its context.

Joaquin Blaya, PhD Moderator Replied at 11:28 AM, 27 Oct 2016

Hi Yudha,
Completely agree with Pratap, and I think you have to also look at the
incentives not only at a technological level but also in the healthcare
system. For example, will hospitals or clinicians be reimbursed the same if
they do a telemedicine consultation as if they do one in person? If not,
there's an incentive to not do telemedicine.

There are also past discussions in GHDonline that could be useful.
A description of the Tanzanian Telemedicine Network (
which I think could be useful to learn from

An expert panel on telemedicine (
where there are various lessons, and also include experts who you might
want to reach out to.


Usman Raza Moderator Emeritus Replied at 12:04 PM, 27 Oct 2016

You may also want to look at the World Bank's Digital Dividends report (
which looks at some of the broader system level issues in eHealth in

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