Abstract
In 2005, the World Health Organization (WHO) formulated a resolution on e-health. 1 This focused on strengthening health systems in countries through the use of e-health. In accordance with this aim, the Global Observatory for e-health (GOe) was established to monitor the evolution of e-health in countries and to support national planning by providing strategic information.
The Observatory's first objective was a global survey of e-health to define a benchmark to measure the growth of e-health. The aim was to provide governments with information that could be used for their own development, as well as a way to compare their own progress with that of other Member States. The first survey was conducted in 2005 and a second survey was conducted in late 2009. This has provided data for a series of eight publications – the Global Observatory for e-health series – which are due for publication in late 2010 and 2011.
The series is targeted at ministries of health, ministries of information technology, ministries of telecommunications, academics, researchers, e-health professionals, non-governmental organizations involved in e-health and donors. The topics of the publications are:
Mobile health; Telemedicine; Management of patient information; Legal and ethical frameworks for e-health; E-learning; E-health policies (a systematic review); E-health foundation actions; Atlas of e-health country profiles.
The survey was sent to all 193 Member States. In each country, a group of 5–15 e-health experts held a one-day meeting to complete the survey. A total of 114 countries (59% of all WHO Member States, representing 81% of the world's population) completed the telemedicine section of the survey. Countries were asked to identify their telemedicine services, and the degree of maturity (informal, pilot, established) in four telemedicine areas.
Table 1 shows the global breakdown of the four telemedicine areas. Teleradiology was by far the most developed telemedicine area, with just over 60% of responding countries offering some form of service, and over 30% of countries offering an established service. While the proportion of countries with any form of service ranged from almost 40% for teledermatology and telepathology to approximately 25% for telepsychiatry, the proportion of countries with established services in those three areas was similar, at approximately 15%, implying that these fields of telemedicine are far less well-established than teleradiology.
Global implementation of four common telemedicine services. Values shown are percentages of 114 responding countries
The telemedicine report analyses the uptake of telemedicine in terms of the WHO administrative regions and the World Bank income groups. The six WHO regions are Africa, the Americas, South-East Asia, Europe, Eastern Mediterranean and Western Pacific; the World Bank income groups are High, Upper-middle, Lower-middle and Low. The survey found that the provision of telemedicine services was far more advanced in high-income countries than in the other World Bank categories. However, there was little difference between upper-middle, lower-middle and low-income groups regarding the proportion of countries with established telemedicine services. The WHO African and Eastern Mediterranean Regions generally had the lowest proportion of countries with established telemedicine services, and a higher proportion of countries offering informal telemedicine services than other regions.
The survey explored other telemedicine services offered by responding countries beyond the four fields specifically surveyed. Table 2 illustrates the diversity of medical services currently offered through telemedicine. The predominant services reported were in the fields of cardiology and electrocardiography (ECG), with 28 countries providing these through telemedicine. Other relatively common services offered via telemedicine included ultrasonography, mammography and surgery.
Other telemedicine services offered
The survey further explored whether countries were working within the framework of a telemedicine policy or strategy, and the extent of involvement of scientific institutions in the support and development of telemedicine. It found that a small proportion of telemedicine initiatives had been formally evaluated. Only 20% of responding countries reported having an evaluation or review on the use of telemedicine in their country since 2006. The final section of the survey investigated what the main barriers were to the implementation of telemedicine in countries, and what information they needed to support the development of telemedicine.
The telemedicine report is due for release in December 2010 in electronic format and shortly afterwards in print. Translations will be made available in Arabic, Chinese, French, Russian, Spanish and Portuguese in early 2011. The Internet version will be available at
Footnotes
Acknowledgements
The data for the report was the result of collaboration between 114 WHO Member States, national and regional offices of the WHO and the GOe. The report was developed by the GOe in partnership with the E-health Policy Unit at the University of British Columbia.