Experiences in countries like Cambodia, Kosova and Uzbekistan has shown that low bandwidth can reach very remote areas. And in fact it has been said telemedicine may have more impact in developing countries than in developed countries. Obviously cost will be the major determining factor. However, I think the long term benefits far outweigh the costs.
Once set up and running there are many challenges that will have to faced. From my own experience in PNG, technical and system support must be regular and continuous. Lack of these kind of support may lead to virus or worm infection. A regular and reliable Internet connection is also very vital and it must be affordable. In the PNG context, Telikom PNG may become a partner in telemedicine in PNG so as to subsidise the cost of telecommunication in telehealth.
A major challenge of telemedicine in developing countries will also be how local telemedicine service providers will carry own after the “out side help” has moved on. There are many examples in PNG where after the donor funding agencies move on after the planned funding period (eg five years) of project, in most instances, the locals are not able to maintain and continue whatever that was established with donor funding. Systems have to be set up for the telemedicine services to be self sufficient. This will also allow softwares and hardwares used to be updated regularly.
Another thing that need consideration is that once telemedicine is set up in a developing country, care must be taken so that the locals do not become too dependent on the “outside” help. Telemedicine must be not be used to replace existing health care systems in developing countries but rather must complement them.
Questions of legal implications in case of a law suit have also been raised. For example, if a specialist in USA makes the diagnosis of a case in Enga province, PNG, and it turns out that the diagnosis was wrong. And knowing Engans, they decide to take the doctor to court for professional negligence, the question now is, under which jurisdiction will the doctor be tried? Papua New Guinea or USA?
Having said all these, telemedicine has a lot more potential and its a new field of medicine that is evolving with information communication technology that seem to change daily. I think if we bear the challenges in mind, telemedince may in fact help solve some our problems of specialists shortage and quality health care delivery to remote areas.