title: Recommendations for the Improved Effectiveness and Reporting of Telemedicine Programs in Developing Countries: Results of a Systematic Literature Review.
abstract: BACKGROUND
  A lack of decisive evidence on the impact of telemedicine on financial and clinical outcomes has not prohibited significant investment in developing countries. Understanding characteristics that facilitate effective telemedicine programs is required to allow telemedicine to be used to its full potential. This systematic review aimed to identify organizational, technological, and financial features of successful telemedicine programs providing direct clinical care in developing countries.
  
  
  METHODS
  Databases were searched, and the results were reviewed systematically according to predefined inclusion/exclusion criteria. Information on location(s), measure of success, and organizational, technological, and financial characteristics were extracted. This review was impeded by inadequate program reporting, and so a concise checklist was developed to aid improved reporting, enabling future reviews to identify key characteristics of effective programs.
  
  
  RESULTS
  This systematic review identified 46 articles reporting 36 programs that fulfilled the inclusion/exclusion criteria. Programs were distributed globally, including regional, national, and international programs. Technological modalities included synchronous technology, real-time teleconsultations, and asynchronous technology. Program integration with existing systems and twinning of international institutions were identified as factors enabling program success. Other factors included simple and easy-to-use technology, ability to reduce the burden on healthcare professionals, and technology able to maintain functionality in challenging environmental circumstances. Reports describing effectiveness and costs were limited.
  
  
  CONCLUSIONS
  This systematic review identified key factors associated with telemedicine program success. However, inconsistencies in reporting represent an obstacle to establishment of successful programs in developing countries by limiting the application of previous experiences. Adhering to the guidelines suggested here may allow more quantitative assessments of effectiveness and impact for future programs.
authors.affiliation: 1 Institute of Medicine, Tribhuvan University , Maharajgunj, Kathmandu, Nepal .
authors.forename: Sumesh
authors.initials: S
authors.lastname: Khanal
authors.affiliation: 2 Costello Medical Consulting Ltd., Cambridge , United Kingdom .
authors.forename: Joseph
authors.initials: J
authors.lastname: Burgon
authors.affiliation: 2 Costello Medical Consulting Ltd., Cambridge , United Kingdom .
authors.forename: Saoirse
authors.initials: S
authors.lastname: Leonard
authors.affiliation: 2 Costello Medical Consulting Ltd., Cambridge , United Kingdom .
authors.forename: Matthew
authors.initials: M
authors.lastname: Griffiths
authors.affiliation: 2 Costello Medical Consulting Ltd., Cambridge , United Kingdom .
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Eddowes
mesh_terms: D003906:Developing Countries; D014943:Global Health; D006801:Humans; D015397:Program Evaluation; D018511:Systems Integration; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*
keywords: extreme environments; information management; technology; telemedicine