In what circumstances is telemedicine appropriate in the developing world?

OBJECTIVES: To review papers reporting actual experience with telemedicine in developing countries and to summarize their findings, including the strength of the evidence. DESIGN: A retrospective review was conducted. Study quality was assessed. SETTING: Four commonly-used electronic databases. MAIN OUTCOME MEASURES: Study quality scores. RESULTS: From a total of 202 potential articles, 38 relevant papers were identified. Thirty-four articles (89%) reported clinical experience and 14 articles (37%) reported the use of telemedicine for educational purposes. The quality of the reports was rather weak (median quality-score 3, on a scale 0-9); only one study, rated at 7, fell into the high quality score band. The fact that almost all studies reported positively in favour of telemedicine suggests a publication bias. Of the 38 articles, 15 (39%) reported the use of real-time telemedicine and 25 (66%) reported the use of asynchronous, or store-and-forward, telemedicine. Email was the most commonly reported modality (half of all studies). CONCLUSION: Some of the longer established telemedicine operations have developed into substantial networks. The review suggests that great potential exists for telemedicine in the developing world. However, some caution is required in future telemedicine work if telemedicine exemplars are to be produced which can be widely copied.