Advancing

Telemedicine
in Asia
Enabling Environments
& Emerging Opportunities

August 2024
Acknowledgements
This report was developed under the Digital Square initiative
at PATH with support from the United States Agency for
International Development (USAID), Bureau for Asia.

Digital Square is a PATH-led initiative funded and designed

by USAID, the Bill & Melinda Gates Foundation, and a
consortium of other donors.

This report was designed by Studio Subu, with additional

design input from S Nandita at PATH. Digital Square would
like to recognize the contributions from (in alphabetical order
by last name) Sameer Kanwar, and Varun Kaul.

This report is made possible by the generous support of the

American People through USAID. The contents are the
responsibility of PATH and do not necessarily reflect the views
of USAID or the United States Government.

© 2024 PATH. Some rights reserved

Recommended citation
Digital Square. Advancing Telemedicine in Asia: Enabling
environments and emerging opportunities. PATH; 2024
Contents

Abbreviations
2 Defining
Telemedicine
Page 7

Next Page

1
Background
Page 1
 4
Policy
Requirements
to Enable
Telemedicine
Page 29

3
Technology
Requirements
to Enable
Telemedicine
Page 17

5
Opportunities
to Advance
Telemedicine
in Asia
Page 43

Annexure
Page 59
 Abbreviations
AI Artificial Intelligence

CHW Community Health Worker

DFS Digital Financial Services

DPI Digital Public Infrastructure

DPI-H Digital Public Infrastructure for Health

eHealth Electronic Health

EHR Ehealth Record

HSP Health Service Provider

ICT Information and Communication Technology

ID Identification

IoT Internet of Things

mHealth Mobile Health

RMP Registered Medical Practitioner

USAID United States Agency for International Development

WHO World Health Organization

Chapter 1

Background

1
 Across Asia, telemedicine has undergone significant transformation
as technology has advanced, evolving from basic telephone
consultations to sophisticated digital platforms. Breakthroughs across
the continent such as the development of video conferencing systems
in the 1970s facilitated real-time interaction between patients
and health care providers.

In South Korea, the establishment of telemedicine networks in the early

2000s by private companies like Samsung and LG contributed to the
expansion of telemedicine services.

Noteworthy public-private pilots include the partnership between

the Indian Space Research Organisation (ISRO) and Apollo Hospitals
to establish telemedicine centers in remote villages in south India.
These centers utilized satellite technology to connect patients with
specialists. Additionally, the deployment of telemedicine vans equipped
with diagnostic tools and video conferencing capabilities facilitated
access to health care in underserved regions.1

Although early private sector efforts helped fast-track innovation

for telemedicine, they often struggled to achieve widespread adoption
and scalability. This resulted in a growing list of isolated demonstration
projects, ultimately contributing to the prevalence of the phenomenon
of “pilotitis” in health in the early 2000s.

Early projects were hindered by the complexity of the technology and the
lack of necessary infrastructure among potential users, both health care
providers and patients. Health system managers often lacked the
knowledge and expertise to manage the integration of these technologies
into health systems which significantly impeded the broader
implementation of telemedicine solutions.2

Another challenge faced by telemedicine was the diminished

level of personal interaction and attention from health care providers.
The perception that increased digitalization in medical consultations
often leads to physicians focusing more on their computer screens than
on direct patient engagement was highlighted through multiple studies.
This reduction in personal engagement seemed to adversely affect the
patient’s experience and satisfaction with telemedicine services.3

Regulatory hurdles further impeded the expansion of telemedicine.

As a developing innovation telemedicine evolved rapidly, far outpacing
the development of comprehensive regulatory frameworks. Governments
were hesitant to enact sweeping regulations on a technology that was
evolving by the day, leading to uncertainty and ambiguity in the legal
landscape surrounding telemedicine.4

Advancing Telemedicine in Asia | 2024 Report

So, the question that emerges is:
How does one regulate a technology that is not fully
understood or has not yet fully developed?
The answer is complex. Despite its potential to save lives,
concerns about misuse and patient safety further
complicate regulatory efforts, creating barriers to the
adoption of telemedicine on a larger scale.

Where We Are The COVID-19 pandemic accelerated the mainstream adoption of digital
Today health platforms across the globe. Faced with lockdowns and social
distancing measures, health care systems turned to digital platforms to
ensure continuity of care. Telemedicine was a core part of this mainstream
adoption. Regulatory changes that concern leveraging remote health care,
its practice, and the surrounding ecosystem eased the widespread
adoption of telemedicine.5

These changes differed across countries. While some countries, like

Singapore, relaxed their previously implemented telemedicine guidelines
to allow quicker adaptation, others, like Japan, centralized and
strengthened their guidelines to ensure regulated scale by the private
sector. Further, as was in the case of South Korea, the pandemic’s end
prompted the government to retract and rework their telemedicine
policies that had been launched pre-pandemic based on their experiences
during COVID-19.

These regulatory changes, coupled with advancements

in technology, have propelled telemedicine into the mainstream,
transforming health care delivery models beyond the pandemic.

3
 In 2023, the global telemedicine market
was valued at over US$120 bn, projected
to cross US$280 bn by 2030.

Figure 1. Percentage of survey respondents who used telemedicine in 2019 and 2023

2019 25%
INDIA
2023 55%

2019 29%
IND ONESIA
2023 58%

2019 11%
MALAYSIA
2023 33%

2019 16%
SINGAP ORE
2023 43%

Source: Adapted from Bain & Company, Asia-Pacific Frontline of Healthcare Consumer survey, 2020 and 2024.
Note: Respondents were asked about telehealth usage in the past 12 months across 2019 and 2023. Growth
percentage has a deviation of +/- 1% due to rounding off. 2019 (n= 1823), 2023 (n= 2300).

Beyond financial metrics, the lasting impact of the pandemic on

telemedicine is evident by its integration into routine health care practices,
with many health-seeking individuals seeing these consultations as
a long-term supplement rather than a replacement to conventional
care models.

While Figure 1 depicts only a small sample of health-seekers across

Asia and does not represent countries as a whole, it does indicate that
post pandemic these consultations have become more commonplace,
offering convenience and accessibility to patients. They typically include
services such as real-time video appointments with physicians
and remote monitoring of chronic conditions using wearable devices,
and online prescription management. Health care providers and seekers
both seemed to have embraced telemedicine as a valuable tool in
delivering patient-centered care, overcoming geographical barriers,
and expanding access to health care services.6

Advancing Telemedicine in Asia | 2024 Report

The Purpose

Aligningi with the United States Agency for

International Development (USAID) Digital Policy
and Digital Health Position Paper,7 this resource
focuses on informing efforts to advance Asian
regional capacities for telemedicine, and, in turn,
digital health. Through secondary research, this
document aims to define telemedicine and its
components, understand the institutional factors
that enable its adoption, and explore where the
opportunities lie to drive this health service delivery
innovation at scale across countries in Asia.ii

i Aligning with policy goals ‘Transform’ and ‘Protect’, and Priority #2 in the position paper.

ii The “Asia region” from this point on in the resource will restrict itself to the 18 countries that are the focus
of USAIDs Bureau for Asia. These include 15 countries with bilateral missions and 3 countries with regional
missions. These can be found on their official website here.

Our Target Audience This resource is tailored for policy decision makers and
individuals tasked with financing, designing, or overseeing
telemedicine initiatives in the Asia region. It provides
potential opportunities and research-based insights to
ensure that telemedicine interventions contribute lasting
value to both the health care system and the communities
they serve. It is important to note that while not exhaustive,
this document offers avenues to scale for consideration
and further exploration.

5
2
Advancing Telemedicine in Asia | 2024 Report
Chapter 2

Defining
Telemedicine

7
Advancing Telemedicine in Asia | 2024 Report
Digital health is the systematic application of information
and communications technologies, computer science,
and data to support informed decision making
by individuals, the health workforce, and health institutions
for strengthened resilience and improved health and
wellness for all.8

The comprehensive field of telemedicine encompasses multiple

technologies and practices designed to enhance health care delivery
and outcomes. Within the expansive domain of digital health, telehealth
and subsequently telemedicine are critical subsets.

While digital health has been largely well defined in the development
community, the definition of telemedicine lacks consensus, leading to
its frequent interchangeability, often mistakenly, with other terms within
the broader digital health domain, such as mHealth, teleconsultation,
telemonitoring, and most commonly, telehealth. This is best exemplified
by a study in 2009, which found 104 different peer-reviewed attempts
at defining telemedicine. This resource positions telemedicine under the
wider ambit of telehealth, which is a more comprehensive term and refers
to the use of electronic information and telecommunication technologies
to support and enhance contactless health care, education,
administration, and related services9.

9
 Definitions of telemedicine often share common core principles
but diverge in the emphasis placed by organizations
on specific aspects tailored to their focus areas.

The Organisation for Economic Co-operation and Development (OECD),

for example, highlights the role of information and communication
technology (ICT) in delivery, defining telemedicine as “the use of information
and communication technologies to deliver health care at a distance.”
OECD’s definition
This underscores technology’s role in bridging geographical divides
and enhancing health care accessibility.”10

Emphasizing the aspects of distance and third-party intervention, the

Centers for Disease Control and Prevention (CDC) and the Federation
CDC and the Federation of State of State Medical Boards define telemedicine as “the practice of medicine
Medical Boards’ definition using electronic communication, information technology, or other means
between a physician in one location and a patient in another location, with
or without an intervening health care provider.”11 Médecins Sans Frontières
(MSF) highlights telemedicine’s crisis response potential in overcoming
barriers to medical care, especially in underserved regions, calling it
MSF’s definition “a service that helps break barriers for access to medical care, [which]
provides improved speed and accuracy for health care services in areas
that are more difficult to access.”12

Perhaps the most widely accepted definition is by the World Health

Organization (WHO), which defines telemedicine as “the delivery of
health-care services where distance is a critical factor, by all health care
WHO’s definition professionals using information and communication technologies for the
exchange of valid information for diagnosis, treatment, and prevention
of disease and injuries all in the interests of advancing the health of
individuals and their communities.” This underscores telemedicine’s goal
of improving health care outcomes and promoting public health
by leveraging technology to transcend geographical limitations.13

Our definition In alignment with the aforementioned definitions,

this resource understands telemedicine as the utilization
of telemedicine of information and telecommunication technologies
to provide health care services remotely, encompassing
consultation, diagnosis, treatment, and monitoring.

This definition succinctly captures the essence

of telemedicine, providing clarity and specificity
to its scope and purpose.

Advancing Telemedicine in Asia | 2024 Report

To further our understanding of telemedicine, we must
dive a little deeper into the three ways in which it can be
conducted: remote monitoring, store and forward,
and synchronous telemedicine.14

Remote Monitoring Store and Forward

Remote monitoring facilitates the remote Store and forward involves the remote storage
tracking of an individual’s health status using and transmission of information, commonly
technologies such as connected medical utilized in non-emergency scenarios. In such
devices and sensors. This approach is instances, health data and images are digitally
commonly employed in managing chronic submitted by patients or specialized health
conditions and is supplemented with workers for deferred consultation. This method
communication channels for care coordination finds application across various medical
or alerts to health workers based on clinical specialties like dermatology, radiology, and
parameters or ranges. ophthalmology, and is characterized as an
asynchronous or deferred mode of digital health
care delivery.
Synchronous Telemedicine
Synchronous telemedicine, also known as
“real-time” or “interactive services” in digital
health care, entails direct communication
between two or more parties in clinical practice.
These interactions aim to provide diagnostic and
therapeutic assistance to clients or patients who
may not have timely access to care otherwise.

11
 Figure 2. Types of interaction in telemedicine

Health Care Provider Health Care Provider Health Care Provider

to Patient to Health Care Provider to Health Care Provider (Assisted)

Direct communication between patients Provider to provider Assisted telemedicine, also known as
and providers, where individuals seek communication, facilitating provider to health worker interaction,
medical advice or consultation remotely. consultations or referrals between involves intermediaries such as nurses or
This interaction utilizes synchronous health care professionals. This type community health workers facilitating
channels such as video calls, audio calls, of telemedicine ensures efficient communication between patients and
or dedicated smartphone applications, collaboration and enables physicians. This approach ensures health
offering convenience and accessibility to specialists to offer expertise care access in remote or underserved
health care services. regardless of geographical barriers. areas where direct doctor-patient
interaction might be challenging.

It is important to note that a single telemedicine solution may not neatly

align with just one of these ways of conducting telemedicine. In fact,
telemedicine solutions often blend elements from all three categories
to meet specific contextual requirements.

Another key aspect while formulating our understanding of telemedicine

is exploring the mechanisms through which telemedicine is implemented.
Briefly, there are three types of telemedicine interactions, including
health care provider to patient, health care provider to health care provider,
and assisted telemedicine, which serve as the last-mile touchpoints
of remote health care delivery. These interactions not only bridge
geographical distances but also facilitate seamless communication
among health care stakeholders, enhancing patient outcomes
and streamlining care delivery processes (Figure 2).

Assisted telemedicine in particular presents an important opportunity

for Asian countries. Low-and-middle-income countries (LMICs) already
have an existing large network of community health workers (CHWs)
who serve as the backbone of primary health care services in rural
and underserved populations through an outreach model.

Notable examples include lady health workers in Pakistan, female

community health volunteers in Nepal, community health officers
and accredited social health activists (ASHAs) in India, and CHWs
in Afghanistan.

Advancing Telemedicine in Asia | 2024 Report

Table 1. Specialized Empowering these intermediaries with advanced support and resources
applications of telemedicine
can significantly enhance the quality of doctor-patient interactions.
For example, a trained and enabled CHW can conduct basic physical
TAILORED TO
examinations, identify relevant symptoms disregarded by the patient,
MEDICAL SPECIALTIES
and utilize connected medical devices to measure vital signs and capture
Tele-ophthalmology
images—tasks that take away additional time from a consultation and
Teledermatology
that patients typically cannot perform themselves. This approach holds
Telepsychiatry
the potential to not only improve diagnostic accuracy and treatment
Tele-oncology
outcomes but also enhance the capabilities of CHWs, making them
Telepathology
Teleradiology
more effective in their roles.14
Telenephrology
Having established a clearer understanding of telemedicine, the ways
Tele-obstetrics
it is conducted, and types of interactions, it is now time to explore
Tele-orthopedics
its specialized applications. These may be tailored to specific medical
specialties, types of care, or targeted conditions. Specialized use cases
TAILORED TO demonstrate both the versatility and adaptability of telemedicine
T YPES OF CARE across various health care domains.
Telerehabilitation
Telecare
Each of these applications showcases how telemedicine can effectively
Teletriage
address unique health care needs, whether it is providing remote
Tele-assessment rehabilitation services (telerehabilitation), conducting virtual eye exams
Telesurgery (tele-ophthalmology), diagnosing conditions remotely (telediagnostic),
Telediagnostic delivering mental health counseling (telepsychiatry), managing cancer
Tele ICU care (tele-oncology), rapidly diagnosing and treating strokes (telestroke),
or facilitating remote diagnostics across various medical facilities
(telediagnostic). These specialized use cases highlight the diverse
TAILORED TO
TARGETED CONDITIONS
range of telemedicine applications, demonstrating its potential to
revolutionize health care delivery across various medical disciplines.
Telestroke
Table 1 provides further examples of these use-case scenarios.
Telecardiology
Tele-oncology
Telediabetes
Telegynecology
Tele-urology
Telepsychology

Figure 3 (next page) aims to situate telemedicine—and the terms discussed

in this study—within the larger ecosystem of telehealth to ensure clarity.
Alongside the primary objective of providing a distilled understanding
of telemedicine, this section also attempts to identify how it is conducted,
the types of interactions involved, and some key prevalent use cases.
Since telemedicine cannot scale in a vacuum, the subsequent sections
connect this topic to the broader technology and policy ecosystem,
shedding light on the essential prerequisites and enablers that allow
telemedicine to drive universal health coverage (UHC).

13
 Figure 3. Telemedicine within the larger telehealth ecosystem

eHEALTH APPLICATIONS mHEALTH

Supportive applications like Medicine and health activities

decision-support systems, EHR, exclusively supported by mobile
and ePrescriptions. devices.

eLEARNING REMOTE ASSISTANCE

Provision of remote training, Enabled assisted living for the

education, or certifications elderly via ICT tools and digital
remotely. means.

TELEHEALTH
TELEHEALTH

ICT-supported-distancehealth
care, education, administration,
and related services.

TELEMEDICINE

Utilization of ICT to provide health care services

remotely, encompassing consultation, diagnosis,
treatment, and monitoring.

REMOTE MONITORING SYNCHRONOUS TELEMEDICINE STORE & FORWARD

Individual health monitoring Real-time video-consultations Differed transmission of clinical
leveraging wearables or or virtual visits leveraging data and reports for supported
specialized monitoring devices. ICT. consultations and diagnosis.

TELETRIAGE TELERADIOLOGY TELEDERMATOLOGY

Use of ICT to provide initial Transmission of medical imaging Individual health monitoring
immediate advice and further for diagnosis and interpretation leveraging wearables or
direction for treatment. in areas like oncology, specialized monitoring devices.
Tuberculosis, etc.

EXAMPLES OF TELEMEDICINE

Targeted area we are focusing on in this resource :: Telemedicine

Source: Adapted from Organisation for Economic Co-operation and Development (OECD), 2023.

Advancing Telemedicine in Asia | 2024 Report

15
3
Advancing Telemedicine in Asia | 2024 Report
Advancing
Chapter 3

Technology
requirements
to enable
telemedicine

17
Chapter 3: Technology Requirements To EnableTelemedicine

Scaling telemedicine initiatives beyond pilot

programs or limited hospital settings relies
heavily on the availability of robust digital public
infrastructure (DPI), essential for ensuring seamless
access to health care delivery. At its simplest,
DPI can be understood as an intermediate layer
in the digital ecosystem. It sits atop a physical
layer—connectivity, devices, servers, data centers,
and routers—and supports an applications layer,
including information solutions to different
verticals, which include unique identifiers,
cash transfers, remote education, and telehealth.

Based on sector-specific DPIs,15 digital public

infrastructure for health (DPI-H) has emerged
as a key enabler for digital health including
telemedicine. This chapter sheds light on the
essential prerequisites of DPI and DPI-H,
necessary for scaling telemedicine efforts,
including connectivity, digital payments,
digital identification, and health databases
and registries.

Advancing Telemedicine in Asia | 2024 Report

[3.1] Connectivity acts as the conduit for remote health care delivery, data
exchange, and patient engagement. High-speed internet and mobile
Connectivity: connectivity are vital, enabling real-time consultations, remote monitoring,
bridging the gap and access to medical information. However, the challenge of connectivity
for universal is multifaceted, particularly in remote and developing regions where
access infrastructure gaps persist.

In remote areas, inadequate fixed broadband infrastructure and erratic

mobile network coverage pose significant barriers to accessing
telemedicine services. The digital divide exacerbates existing disparities
in health care access, leaving already underserved populations at
a disadvantage. Drawing from the example of the geographically dispersed
Pacific Islands, where the cost of mobile broadband is four times the world
average, limited infrastructure investment poses a significant barrier to the
widespread adoption of telemedicine platforms. This perpetuates health
care inequities, exacerbating disparities in access to medical services.16

Despite these challenges, the advancement of mobile networks from

the second generation (2G) to the fifth generation (5G) has enabled
the addition of more complex telemedicine features (Table 2).

For example, the transition to 5G significantly increases the capacity

for connected devices, ensures a lower latency, and supports edge
computing, which processes data closer to the source. For telemedicine,
this potentially means offering higher-quality video consultations, enabling
continuous remote monitoring of patients with chronic conditions through
wearables, transferring higher volumes of medical records, and facilitating
advanced applications like remote surgery and AI-driven diagnostics.

Table 2. How the evolution of connectivity lends itself to more complex telemedicine features

2G 3G

1G 4G 5G

1990–2004 1990–2004 1990–2004 1990–2004 1990–2004

Speed: 0.02 mbps Speed: 0.384 mbps Speed: 56 mbps Speed: 1,000 mbps Speed: 10,000 mbps

Analog Cellular GSM / CDMA GSM / CDMA WiMAX / LTE NR

Technology Technology Technology Technology Technology

Voice Telephony Digital Voice, SMS, & High Quality Audio, Wearable Device Wearable Device with
Data Packets Video & Data Transmission & IoT AI Capabilities

Notes: Abbreviations used include GSM: Global System for Mobile Communications; CDMA: Code Division Multiple
Access; WiMAX: Worldwide Interoperability for Microwave Access; LTE: Long-Term Evolution;NR: New Radio

19
 Contrary to the situation in the Pacific region, affordable mobile internet
rates in South and Southeast Asia have enabled the growth of internet
usage in multiple countries. Although outliers such as Indonesia
(US$1.50 per Mbps) and Pakistan (US$2.35 per Mbps) exist, the average
cost per Mbps in countries like Bangladesh, Sri Lanka, India, and Vietnam
remains below US$1.00. Particularly notable are Singapore, with rates as
low as US$0.16, and Thailand, offering internet at US$0.10 per Mbps,
showcasing some of the most affordable examples.17

These low costs, combined with the advanced capabilities of 5G, make
telemedicine more accessible and effective, especially in regions where
health care infrastructure may be limited. This technological synergy
supports a broader reach and more robust delivery of telemedicine
services, enhancing patient care and overcoming geographical barriers.

Innovative solutions and emerging technology also offer avenues

for bridging the connectivity gap, and, in turn, extending telemedicine
to all corners of the globe. Subsidized low-orbit satellites such as Starlink
represent a promising option for delivering internet connectivity to remote
and underserved areas, supplementing traditional infrastructure.
For example, Starlink was recently granted a license and rolled out
across more than 300 islands in the Republic of Fiji.

Additionally, community-based networks also emerge as potent tools for

addressing connectivity constraints, empowering local communities to
take ownership of their digital infrastructure. Through mesh networkingiii
and shared resources, these grassroot initiatives foster sustainable
connectivity solutions, ensuring continuous access to telemedicine
services, even in the most remote of settings. Moreover, public-private
partnerships play a pivotal role in driving connectivity initiatives, with
tech giants like Google and Facebook investing in projects such as
companion-based networks and wireless backhaul to expand internet
access and bridge the digital divide.18

As telemedicine evolves, it becomes increasingly important to strengthen

connectivity. Collaborative efforts between governments and the private
sector have already spurred infrastructure development in many Asian
countries. However, despite the positive trends, high population and diverse
geography across Asia underscore the considerable scope for further
improvements in connectivity. This includes broader access and affordability
for all, thereby increasing the reach and efficacy of telemedicine initiatives
across the region.

iii A mesh network is a network in which devices (or nodes) such as phones are linked together, branching off other
devices or nodes. These networks are set up to efficiently route data between devices and clients. They help
provide a consistent connection throughout an irregular on otherwise inaccessible physical space.

Advancing Telemedicine in Asia | 2024 Report

[3.2] Digital
identification:
safeguarding
authenticity

As of 2023, approximately 850 million individuals lacked

any form of identification, including paper-based documentation.

An estimated 1.1 billion people lacked a digital footprint for

their identity, while 1.25 billion individuals lacked a digitally
verifiable identity. A staggering 3.3 billion people lacked access
to a government-recognized digital identity, hindering their ability
to securely engage in online transactions.19

Nevertheless, the momentum of digital identity adoption in Asia is positive,

with notable progress seen across multiple countries. In the Philippines,
the Philippines Identification System (PhilSys) has achieved nearly
90 percent coverage of the population, with over 80 million registrations.
Similarly, Indonesia has seen significant uptake, with over six million
residents onboarded for the country’s new digital ID smartphone
application known as Identitas Kependudukan Digital (IKD).

In India, the Unique Identification Authority has generated over 1.3 billion
Aadhaar numbers, representing the largest digital identity initiative
worldwide. Singapore’s Singpass platform has also witnessed remarkable
adoption, with 70 percent of the population actively using it, showcasing
its effectiveness in streamlining processes and enhancing security.
These examples highlight the growing importance of digital identity,
not only for service accessibility but also for driving technological
innovation and governance efficiency.20

While this progress is encouraging, it is essential to recognize and address

the risks associated with digital identity systems, such as data breaches,
verification vulnerabilities, and privacy concerns. Responsibility for
regulating and ensuring security lies with both governmental bodies
and private organizations handling this data. Implementing robust security
measures, conducting regular audits, and fairly enforcing stringent
data protection laws are critical steps to building and maintaining public
trust in digital identity initiatives.19

21
 These foundational digital identification solutions empower patients
to assert control over their personal health information, enabling them
to selectively share data with health care providers and third-party
entities as needed.

Patients can maintain sovereignty over their digital identities, fostering

trust and transparency in telemedicine interactions, by using consent
managers, secure identity wallets, and decentralized identity protocols.
When linked to telemedicine, the growth of digital IDs makes
standardization efforts essential to ensuring compatibility and seamless
integration across health applications, while compliance with data
protection regulations such as GDPR and HIPAA remain paramount to
safeguarding patient privacy and confidentiality.

Public awareness campaigns and education initiatives have been shown

to promote the benefits of digital identification in telemedicine and reduce
misconceptions surrounding data security and privacy. Organizations in
the process of supporting government rollout of IDs can focus on fostering
a culture of trust and accountability, which has emerged as a clear
barrier across literature. Health care stakeholders can then harness
the transformative potential of digital ID to enhance patient safety,
streamline care delivery, and advance the telemedicine paradigm.21

Advancing Telemedicine in Asia | 2024 Report

[3.3] Digital Digital financial services (DFS) encompass a range of financial products
and services delivered through digital channels. These include payments,
financial services: savings, loans, credit, insurance, remittances, and transfers when made
facilitating access through digital means (e.g., mobile phones, ATMs, POS readers, and
to social security NFC-enabled devices). DFS have been shown to significantly enhance
health programs and country-level efforts, accelerating progress toward
global health goals and outcomes.

According to World Bank data, digital transactions across the

Asia region are growing, with 41 percent of the population
(more than 15 years of age) having made or received a digital
payment at least once till 2022 (Figure 4). This surge in digital
financial activity is further underscored by the significant rise
in credit card penetration, which escalated from 13 percent in
2021 to 29 percent in 2022.22

Figure 4. Percentage of total population (15+) that made or received a digital payment in Asia

Kazakhasthan 78%

Uzbekistan 42% Kyrgyz Republic 39%

Bangladesh 45%

India 35%
Vietnam 23%

Philippines 43%

Sri Lanka 55% Thailand 92%

Source: World Bank, 2022.

Notes:
n= 128,000 individuals across 123 countries.
Indonesia 37%
Data includes the 16 countries listed on USAIDs website.
Data for Fiji and Timor Leste unavailable.

23
 The volume of real-time transactions across the region has also seen
exponential growth, with real-time payment systems, like India’s
Unified Payments Interface (UPI), Thailand’s Prompt Pay, and Malaysia’s
DuitNow, making up a significant volume of global transactions made
on digital platforms.23

These payment mechanisms have also lent themselves to cross-border

digital payment integration across several Asian countries, thereby
strengthening the region. Indonesia, Malaysia, and Thailand have
Cross Border Digital Payments interconnected their QR code payment systems to facilitate seamless
transfers between borders. Singapore has followed suit, interlinking its
real-time QR-based payments with those of Thailand and India, with plans
to integrate with Indonesia in 2024. Furthermore, initiatives like UPI in India
are expanding their reach beyond national borders by being made
available to non-resident Indians in 10 countries to facilitate global
remittances.

Additionally, UPI has been adopted by other countries too, like Bhutan and
Nepal, and is in the process of integration with payment systems in Saudi
Arabia and France. This further demonstrates the growing international
significance of Asia’s digital payment ecosystem.24

Efficient financial transactions are essential for the equitable functioning of

digital health platforms, ensuring telemedicine services are accessible to
everyone. Digital payment gateways provide secure methods for handling
transactions, supporting billing, reimbursement, and subscription models.
This integration guarantees fair compensation for health care providers
and smooth access to medical services for patients, including those
covered by social security provisions. By embedding telemedicine into the
broader health system, DFS contribute to a more inclusive, efficient, and
responsive health care delivery model, improving better health outcomes
and reducing disparities.

Integrated DFS streamline telemedicine’s financial aspects, enabling access

to social security benefits for consultations, prescriptions, and other medical
fees. Incorporating payment gateways into country-level DPI, allows health
care providers to deliver a better user experience with stringent security
standards to protect sensitive financial information and ensure traceability.

Additionally, digital payment gateways enhance health care accessibility by

offering flexible payment options tailored to diverse socioeconomic
backgrounds. For underserved populations without traditional banking
services, mobile money platforms and digital wallets provide convenient
alternatives for financial transactions within telemedicine platforms.25

Advancing Telemedicine in Asia | 2024 Report

[3.4] DPI
for Health: A
domain-specific
linkage

DPI for Health or DPI-H is a set of domain specific components

that capitalize on foundational technology infrastructure and
DPIs via a service gateway. These can be thought of as health-
specific building blocks that layer on top of existing DPIs to allow
for integrated digitization of health.

Digital Registries eHealth records

These are databases housing critical information These systems are designed to store, manage, and
on diverse entities like citizens, health care share individuals’ health information digitally.
providers, facilities, and products. Examples from Alongside facilitating secure sharing and
Asia include India’s Ayushman Bharat Digital interpretation of health information between health
Mission (ABDM), which includes the ABHA Health care providers (with patient consent), eHealth
account building upon the national digital ID. record (EHR) platforms enable health care
These registries assign unique and universal professionals to access comprehensive patient
identities to each entity, serving as a singular records, leading to informed decision making,
source of truth. Users can directly access this effective treatment plans, and improved patient
data or integrate it into software and applications outcomes. Additionally, EHR systems play a crucial
in a plug-and-play fashion. While these registries role in anonymizing and aggregating health data,
are relatively static, they can be enriched with allowing for the identification of disease trends and
ancillary data, which changes more rapidly, such evaluation of health program effectiveness while
as provider contact details, to facilitate upholding patient privacy and confidentiality. These
communications. This information may also EHRs are commonly underpinned by standards
include details about facility services and the such as FHIR, Health Level 7 (HL7), and SNOMED
qualifications of health care workers. across Asia to ensure interoperability and seamless
exchange of health data.

Health interoperability or exchange layer

This refers to an open protocol facilitating access
to various digital health services. This open
network links end-user applications and health
service provider (HSP) applications, enabling
patients and HSPs to avail themselves of a wide
array of digital health services. Examples include
Indonesia’s SatuSehat (One Health data system)26
and Thailand’s digitized Universal Coverage
Scheme (UCS), which offer protocols for ID
verification, claims, reimbursement and employ
artificial intelligence (AI) for auditing.27

25
 Countries require anywhere between US$50–250 mniv
of investment to strengthen DPI-H.

Figure 5. Where telemedicine fits within a larger DPI and DPI-H ecosystem

Telemedicine (Applicable in Both)

User Individual Applications Health Care Provider Applications

Application For Example: For Example:
Types Personal Health Records, Hospital, Lab, Management System,
Telemedicine Telemedicine

Digital Registries Unified Health Interface Health Records

Citizens Discover Health Facilities Health Record Standards

and Providers
DPI-H: Healthcare Providers Health Information Exchange
Building Blocks Health Facilities
Book Appointments
Consent Manager
Avail Services
Drugs Anonymization and Analytics
Pay
Others

Foundational
Cross Domain CONNECTIVIT Y I D E N T I F I C AT I O N PAY M E N T S
DPI’s

Once a thorough situational understanding has been established,

partners can engage in collaborative efforts that support governments in
designing substantial, multi-year costed investments, guided by an
implementation roadmap for multiple interoperable DPI and DPI-H
components. Such investments would greatly benefit the implementation
of truly sustainable and scalable telemedicine solutions.

As shown in Figure 5, telemedicine, at its most effective, is only a part of a

much larger enabling environment underpinned by digital infrastructure,
registries, and linkages. While not covered by this resource, a subsequent
step for readers would be to explore how telemedicine fits into an enterprise
architecture ecosystem, examining its role within a broader and more
intricate network of application development. This topic is further explored
in the Digital Health Planning National Systems course,28 which is
highlighted in the resource toolbox (Toolbox #1) at the end of this chapter.

iv This is investment per year, per country, usually projected over a five-year timeline (Co-Develop, 2023).

Advancing Telemedicine in Asia | 2024 Report

 In conclusion, addressing technological foundations is essential for
telemedicine to navigate the complex digital landscape effectively. By
ensuring robust connectivity, secure payment gateways, reliable digital
identification systems, and DPI-H integration, health care stakeholders lay
the groundwork for scalable and interoperable telemedicine ecosystems.
Without these fundamental elements, telemedicine initiatives risk
becoming mired in inefficiencies and the phenomenon of “pilotitis,”
where pilot projects require parallel, high-effort identification,
authentication, and other systems that are not feasible to scale.

In regions where telemedicine initiatives are already in place, integrating

these foundational technologies through approaches such as
DPI as a service (DaaS) would be crucial for scaling and enhancing existing
systems. By incorporating robust infrastructure incrementally, these
regions can overcome initial limitations and move toward more efficient,
scalable operations.

This foundational infrastructure not only supports current operations but

also sets the stage for future growth and innovation. With the integration of
emerging technologies like AI as value-added layers, telemedicine can
potentially enhance its effectiveness and efficiency. This synergy holds
immense potential for scaling medical care to underserved populations,
improving health outcomes, and advancing global health agendas.29

TOOLBOX # 1

Assessing a country’s digital health

maturity and building block status

SOME AVAILABLE RESOURCES A Framework for Conceptualizing DPI-H (Co-Develop, 2023)

WHO Global Digital Health Strategy (WHO, 2022)

The DPI Approach: A Playbook (UNDP, 2023)

USAID Digital Health Investment Review tool (USAID, 2018)

Global Digital Health Monitor (Global Development

Incubator, 2023)

Digital Health: Planning National Systems Course

(USAID, ITU, WHO 2021)

27
4
Advancing Telemedicine in Asia | 2024 Report
Chapter 4

Policy and
governance
requirements
to enable
telemedicine
29
 Policy is pivotal in advancing telemedicine, as it
necessitates robust frameworks and guidelines
to ensure its scalability, effectiveness, and safety.
As per the WHO, policies that affect telemedicine
are multidimensional, encompassing laws,
regulations, and strategies that influence
its implementation.30

Legal and regulatory policies, which may not

specifically target telemedicine or health but impact
its practice (e.g., pertaining to wider digital or
health system contexts)

Core telemedicine policies, which directly

address telemedicine services

Digital health policies, which ensure telemedicine

integration into broader national health objectives
and policies

Advancing Telemedicine in Asia | 2024 Report

[4.1] Legal Legal and regulatory policies do not directly address telemedicine but
comprise a range of enforceable laws and regulations across multiple
and regulatory domains. These include both health-related policies like medical licensure
policies or drug prescription regulations, as well as overarching policies such as
data security, privacy, or consent laws. Table 3 expands on some of these
key policies, likely governance authorities, and their potential downstream
effect on telemedicine.

Table 3. Key legal and regulatory policies impacting telemedicine

BROAD WHAT IS GOVERNANCE P OTENTIAL IMPACT ON

REGULATION REGULATED? AUTHORIT Y V TELEMEDICINE SERVICES

Data privacy Regulation of Ministry of IT / ICT / Ensures confidentiality and security of patient data
laws collection, storage, Electronics transmitted during telemedicine consultations.
sharing, and Protects patient privacy and fosters trust in remote
permanent deletion health care.
of personal data

Consent Protocols for obtaining Ministry of IT / ICT / Ensures that patients understand the risks and
frameworks informed consent Electronics benefits of telemedicine. Establishes clear consent
from citizens for processes for remote consultations, enhancing
digital services patient autonomy and trust in telemedicine.

National digital Infrastructure and Ministry of IT / ICT / Facilitates interoperability between telemedicine
architecture standards for digital Electronics platforms and health care providers. Improves
systems within a access to telemedicine services by creating a
country cohesive digital health care ecosystem.

Practitioner Regulations National Medical Streamlines licensure processes for telemedicine

licensure determining the Council / National practitioners, expanding access to remote health
authorization of health Medical Association care services across state or national borders.
care providers to Ensures provider competence, practitioner
practice discovery, and patient safety.

Code of conduct Professional Ministry of Health Maintains quality and ethical standards in
of health care standards and telemedicine practice. Reduces risk of malpractice
providers guidelines for health and ensures patient safety during remote
care practitioners consultations. Upholds professionalism and trust in
telemedicine.

Malpractice / Legal standards and Ministry of Health / Establishes accountability for health care
medical consequences related Ministry of Justice professionals in telemedicine, reducing the risk of
negligence to medical errors and ensuring patient safety.
malpractice and
negligence

Guidelines for Protocols for National Drug or Ensures safe and appropriate prescribing practices
drug prescription prescribing medical product during remote consultations. Provide the guidance
medication, including boards / Ministry of on how patient identity is verified, and if digital
in telemedicine Health T prescriptions can be provided based on a virtual
settings consultations.

v This is a broad selection of the likely governance agencies separated with a ‘/’, based on an understanding of the Asia region.
Rather than be prescriptive, it is meant to provide the reader with a broad understanding of likely governance authorities.

31
 It is crucial to recognize that legal frameworks vary between countries,
and specific regulations may not be identical either in content or
nomenclature. In some cases, regulations may be subsumed within
broader laws. For instance, malpractice laws might be integrated into
comprehensive health care code of conduct regulations.

In the Asia region, countries like Bangladesh, India, Vietnam,

and Sri Lanka stand out for their available and ratified legal and regulatory
frameworks. They feature personal data protection acts, clear digital
drug prescription guidelines, and well-defined practitioner policies,
amongst others. Meanwhile, Pakistan, the Philippines, Myanmar, and
Uzbekistan are witnessing rapid regulatory development but still have
gaps in certain areas. Efforts are needed to strengthen regulation
in countries like Afghanistan, Kazakhstan, Fiji, and Timor-Leste, where
many regulations are not available or require significant development
(Table 4, on page 34).

Common challenges to implementation in the region

have included coordination between regulatory authorities
during enforcement, collaboration with civil society when
updating regulations, and lack of awareness and in-turn
compliance by the population.

While partners cannot directly draft or implement legal

and regulatory policies, supporting best practice exchange
can benefit in the implementation of aligned regulatory
and legal frameworks to ensure the safe and ethical scaling
of telemedicine.31

These overarching policies and regulations are not only enablers but also
crucial determinants shaping how health data, health privacy, and health
platforms are regulated as health technology scales. As telemedicine and
other health technologies advance, they rely heavily on these underlying
frameworks to draw regulatory boundaries. Thus, ensuring robust and
comprehensive legal and regulatory frameworks becomes imperative to
safeguarding patient rights, promoting ethical practices, and fostering
innovation in health care delivery across the Asian continent.

Advancing Telemedicine in Asia | 2024 Report

[4.2] Dedicated The landscape of telemedicine policies across Asia remains varied and, in
many cases, nascent. A recent study conducted across 51 Asian countries
telemedicine revealed that only 20 countries, comprising approximately 39 percent of the
policies total, have some form of telemedicine law, policy, regulation, or guidelines in
place. Among these, 15 countries have enacted binding telemedicine laws,
signaling a growing recognition of the importance of formal regulation in
governing telemedicine practices.

As discussed in Chapter 1, telemedicine utilization in most Asian countries

prior to the pandemic was limited and often hindered by regulatory
barriers. However, the unprecedented disruptions caused by the pandemic
prompted swift government responses aimed at promoting telemedicine
adoption.

Many governments expedited telehealth reforms, introducing policies and

regulations within weeks that would otherwise have taken years to develop
and implement. This rapid transition underscores the critical role of
telemedicine in maintaining continuity of care during crises and has
catalyzed the integration of telemedicine into mainstream health care
systems across Asia (Table 4, next page).

33
 Table 4. Snapshot of telemedicine policies and their overseeing authority across the Asia region

COUNTRY TELEMEDICINE P OLICY AND YEAR GOVERNANCE AUTHORIT Y

Bangladesh Telemedicine Guidelines, 2020 Ministry of Health and Family

Welfare – Directorate General of
Health Services

India Telemedicine Practice Guidelines, 2020 Minsitry of Health and Family

Welfare

Indonesia Health care services during the Ministry of Health – Kemenkes

COVID-19 pandemic:
1. IMC Regulations, 2020
2. Ministry of Health Decree No. HK.01.07/
MENKES/4829/2021 – Guideline on
Telemedicine, 2021

Japan 1. Medical treatment using telephones Ministry of Health, Labor and

and information communication Welfare
equipment during the spread of new
coronavirus infections
2. Guideline concerning proper
implementation of telemedicine, 2022

Kazakhstan Code of the Republic of Kazakhstan on Ministry of Healthcare

Public Health and Healthcare System, 2020

Malaysia Malaysian Medical Council Advisory on Ministry of Health

Virtual Consultation (during the Covid-19
pandemic), 2020

Nepal Telemedicine Guidelines for Registered Ministry of Health and Population

Practitioners in Nepal

Pakistan Policy for Telemedicine in Pakistan, 2022 Ministry of National Health Services
– Regulation and Coordination

Philippines DOH-DILG-PHIC Joint Administrative Order Department of Health

No 2021-0001 titled Guidelines on the
Implementation of Telemedicine in the
Delivery of Individual-based Health Services

Singapore 1. National Telemedicine Guidelines, 2015 Ministry of Health

2. Health Services Act, 2023

Thailand Notification on Guidelines in respect to Ministry of Public Health –

Telemedicine and Online Clinics No. 54/2563 Department of Medical Services
(2020)

Vietnam Circular No. 30/2023/TT-BYT on Ministry of Health

promulgating list of diseases and health
conditions subject to telemedicine, 2023

Advancing Telemedicine in Asia | 2024 Report

 While dedicated telemedicine policies are crucial for scaling telemedicine,
effective governance requires collaboration between the ministry of health
and the ministry of Information and Communications Technology (or its
equivalent). This interaction often results in comprehensive data
management, privacy, and consent frameworks, as well as the seamless
rollout of advanced technologies, relevant for digital health initiatives like
telemedicine. Most guidelines mentioned in Table 4 designate the MoH as
the primary decision-maker for telemedicine, with countries like Thailand
and Pakistan identifying sub-divisions within the ministry.

However, involvement of Ministries of ICT, or equivalent regulatory bodies, is

often overlooked. This collaboration is essential for addressing the
technological and data-related challenges of telemedicine. The figure
below illustrates two successful approaches to telemedicine ownership
and governance, highlighting the importance of cross-ministerial
collaboration.32
Sandbox Model
Singapore successfully rolled out nationwide telemedicine through the
Licensing Experiment and Adaptation Programme (LEAP) in 2018 using a
“sandbox” governance model. This model allowed the Ministry of Health to
partner with private telemedicine providers, such as Doctor Anywhere and
MyDoc, to manage risks and co-create regulatory and governance
measures. After three years, the sandbox was closed in 2021, transitioning
to formal regulation under the Ministry of Health via the Health Services Act
in 2022.
Centralized Governance and
Development Model In contrast, India’s centralized governance and development model for its
rapidly scaling telemedicine solution, eSanjeevani33, was conceptualized by
the Ministry of Health and Family Welfare (MoHFW) in 2018. The Centre for
Development of Advanced Computing (CDAC), the R&D arm of the Ministry
of Electronics and information Technology, initially developed and
continues to operate, maintain, and update the software as the technical
partner. This model demonstrates a more centralized approach with the
MoHFW retaining ownership and governance while leveraging CDAC’s
technical expertise.

Common themes observed across the telemedicine laws and guidelines

specified in Table 4 include requirementsvi for registered medical
practitioners for both public and private licensed health care professionals
to provide telemedicine services, patient consent for teleconsultations,
adherence to ethical standards and medical codes of conduct, and
compliance with data protection laws to ensure patient confidentiality.
Moreover, telemedicine regulations in countries with binding laws often
impose penalties for negligence, misconduct, or privacy breaches by health
care professionals, ranging from license suspension or cancellation to fines
and imprisonment.

vi It is important to note that while a majority of these guidelines underscore the significance of these
requirements, enforcement often relies on other legally binding regulations or laws.

35
 In countries where there has been progress across
these regulations, particularly in the Southeast Asia
region, it is interesting to note the contextualized
and nuanced nature of these policies. The notes
listed in the next page illustrates these nuances
in telemedicine guidelines across five countries —
Bangladesh, India, Indonesia, Nepal, and Thailand,
(mentioned in Table 4).

This limited selection is intended to offer a more

focused and comprehensible example set, aiding
the reader’s understanding.34

Advancing Telemedicine in Asia | 2024 Report

Registered medical Prescription
practitioners (RMPs) guidelines
Telemedicine guidelines for all five countries Prescription guidelines in India, Nepal,
address the use of telemedicine by practitioners, Bangladesh, and Indonesia have strict
ensuring that only registered medical regulations on the types of drugs that can be
practitioners (RMPs) across both public and prescribed over teleconsultation, while Thailand
private health are authorized to engage in such outright prohibits prescribing via a
practices. In Nepal and Indonesia, RMPs must teleconsultation. While some telemedicine
possess thorough knowledge of telemedicine policies may mention these drugs as a guideline,
principles and technology by taking detailed they are regulated by multiple drug and
online courses. Similarly, in India and pharmaceutical laws that are legally enforceable.
Bangladesh, RMPs are required to complete For private providers, these guidelines act to
mandatory online courses to qualify for providing mitigate risks such as misdiagnosis or
online consultations. Thailand mandates health overprescription for additional profit, which can
care providers to file forms with the health compromise patient safety and quality of care in
authority to include telemedicine in their telemedicine settings.
services. Interestingly, India and Bangladesh
have explicitly prohibited technology platforms
based on AI or machine learning from counseling
or prescribing medications to patients. Consent
frameworks
Consent frameworks are a critical aspect
addressed in all guidelines, albeit with
Patient verification and differences. While explicit consent is required in
authenticity mechanisms Thailand and Indonesia, implied consent is
allowed in India, Bangladesh, and Nepal.
Patient verification and authenticity mechanisms
Recording telemedicine sessions is currently
vary across these countries. In India, Nepal, and
required by guidelines in four countries, with the
Bangladesh, RMPs must ensure mechanisms for
exception of Nepal where it is not explicitly
patients to verify their credentials and contact
mentioned. However, guidelines across all
details. Verification involves confirming patient
countries lack specifics on how recordings
identity through various details such as name,
should be maintained and for what duration.
age, gender, address, and phone number, with
additional provisions for minors requiring
consultation with an adult. Conversely, Thailand
and Indonesia lack specific instructions for
patient verification, although adherence to
Telemedicine platforms
standard operating procedures and regulations are subject to regulations
is expected. Telemedicine platforms are subject to
regulations, with stricter guidelines in India and
Bangladesh. These platforms must ensure RMP
registration, provide practitioner details, and
establish grievance redressal mechanisms to
reduce reinforcement of misaligned incentives.
Thailand and Indonesia mandate adherence to
existing data safety and security laws.

37
 Despite the progress made in establishing telemedicine policies,
there remain opportunities for further action, particularly in countries
like Myanmar,vii Fiji, and Cambodia that lack formally ratified telemedicine
guidelines. In such cases, telemedicine implementation has been
listed as an objective under the national health strategies, although
the status of implementation remains unclear. Countries like Afghanistan
and Sri Lanka, without formal laws in this regard have witnessed
the emergence of telemedicine systems and networks operated by
non-government entities or private parties, often in collaboration with
local governments, international organizations, and charitable institutions.
These initiatives underscore the grassroot efforts to leverage telemedicine
to address health care gaps and improve access to quality care in
underserved communities.

[4.3] Policy Highlighted in global documents like USAID’s Vision for Action in
Digital Health and WHO’s Global Digital Health Strategy, the need to invest
foundation for in foundational digital health policies aligned with country-level health
telemedicine: goals is well documented. This alignment of digital health strategies to
embedding in policies has been noted by many countries across Asia. Digital health
a digital health strategies are also often developed sequentially following national health
strategy policies. Moreover, these strategies emphasize the importance of aligning
with national health policies to achieve overarching health objectives.

This coherence ensures that digital health initiatives address current

health challenges and significantly contribute to national health goals.
Establishing a robust policy foundation for digital health initiatives, including
telemedicine, requires aligning digital health strategies with national health
A real-time example of this is the agendas. This alignment enhances their effectiveness in addressing
Republic of Fiji, which is health challenges and improving health outcomes.
sequentially building out its
policy landscape. The country
In Asian countries where digital health strategies are being formulated,
launched two strategic health
plans—2020–2025 and 2030—
promoting the inclusion of telemedicine as a focal point within the
which clearly laid out national strategy will facilitate the development of cohesive and interconnected
health priorities, including a clear telemedicine guidelines. In cases where telemedicine policies were
emphasis on the digital established before the digital health strategies came into practice,
landscape. Fiji then launched
this integration can serve as a catalyst to bolster existing telemedicine
its digital health strategy in 2024,
embedding it within the health frameworks. For example, Indonesia issued telemedicine guidelines
policy goals and identifying in 2020 due to COVID-19, and their 2021 Blueprint for Health Digital
telemedicine as a key tool Transformation Strategy 2024 highlighted the need to improve these
for progress.
guidelines for future scaling.

vii The guidelines for Myanmar mentioned in Table 4 are understood to be temporary, and specific to the pandemic

Advancing Telemedicine in Asia | 2024 Report

Privacy and Security:
Overarching Concerns

As digital identity, financial services, connectivity, and their

subsequent policies become more intertwined in Asia’s increasingly
digitized health ecosystem, privacy and security concerns loom large.
While chapters 3 and 4 touched on these concerns, the following
paragraphs briefly expand on them and provide potential avenues
for strengthening privacy and security measures.

Experiences with data breaches have made the public cautious about the
vulnerabilities inherent in these technologies. Incidents across countries
involving unauthorized access to personal financial information or
healthcare records highlight the urgent need for robust security measures.

Governments and private entities handling sensitive data, such as

individual’s HIV status, mental health records, reproductive health
information, or gender identity, must implement stringent protocols to
protect against breaches and uphold patient confidentiality amidst
societal stigma and discrimination concerns.

What does it take to improve To improve privacy and strengthen data security, the use of tools like
privacy and strengthen data encryption, multi-factor authentication, and regular security audits has
security?
been growing, and should continue to be encouraged. Encryption encodes
data during transmission and storage, preventing unauthorized access.
Multi-factor authentication adds an extra layer of security by requiring
users to verify their identity through multiple methods, such as passwords
and biometrics. Regular security audits and vulnerability assessments help
identify and mitigate potential risks before they can be exploited.

Additionally, DFS need to implement secure payment gateways and fraud

detection systems to protect transactions and personal financial data.
Consent managers and secure identity wallets empower individuals to
control how their information is shared, fostering trust and transparency
in digital interactions. Consent managers (p.26) allow users to manage
and selectively grant permissions for data sharing, ensuring that sensitive
information is disclosed only with explicit consent. Secure identity wallets
(p.14) provide safe storage for digital identities, reducing the risk of identity
theft or fraud. By collectively leveraging these measures, the resilience of
digital ecosystems can be strengthened against threats while promoting
responsible data stewardship.

39
 In conclusion, the successful deployment of telemedicine
interventions demands a strategic approach. This entails not only
leveraging existing legal and regulatory structures to fortify them
but also crafting dedicated telemedicine policies that provide
a clear roadmap for scalability.

Furthermore, it necessitates embedding these initiatives within

comprehensive digital health strategies, ensuring alignment with
overarching national health care policies, and addressing privacy
and security concerns. By adopting this multifaceted approach,
we can effectively propel the advancement of telemedicine
and maximize its potential impact on health care delivery.

TOOLBOX #2

Telemedicine implementation
frameworks and guides that account
for comprehensive policy enablers

SOME AVAILABLE RESOURCES Comprehensive telemedicine

implementation guide (WHO, 2023)

Framework for the implementation of telemedicine

as a service (WHO, 2017)

Assessing the maturity level of health institutions

to implement telemedicine services (PAHO, 2020)

Global standards for accessibility of telehealth

services organisation (ITU and WHO, 2022)

Advancing Telemedicine in Asia | 2024 Report

41
5
Advancing Telemedicine in Asia | 2024 Report
Chapter 5

Opportunities
to advance
telemedicine
across Asia

43
 The potential of telemedicine to address global
health challenges, when viewed as part of a larger
enabling ecosystem is undeniable. The available
literature underscores its transformative impact on
health care disparities and access to quality care.

Asia has a history of unsuccessful siloed

telemedicine initiatives, emblematic of the
scalability challenges prevalent in the digital health
community of the early to mid-2000s. Despite
these setbacks, our examination sheds light on
the region’s evolving landscape, highlighting
resilience and adaptability in overcoming
past obstacles.

Throughout this resource, we have analyzed the essential relationship

between enabling technology, essential policies, and telemedicine. This is
crucial for the sustainable growth of telemedicine while prioritizing the
safety of health seekers. Focus must remain on necessity of DPI, DPI-H, and
comprehensive forward-looking regulations to foster an environment
conducive to telemedicine innovation and implementation. We have
observed promising progress in both technological advancements and
policy frameworks across Asia. However, the pace and scope of these
advancements vary significantly among countries, which reflect the diverse
health care landscapes in the region (Table 5).

Advancing Telemedicine in Asia | 2024 Report

Table 5. Progress comparison across 18 Asian countries

COUNTRY TECHNOLOGY ENABLERS P OLICY ENABLERS

CONNECTIVIT Y DIGITAL DIGITAL DPI-H LEGAL & TELEMEDICINE DIGITAL HEALTH

PAYMENTS ID SECURIT Y P OLICY STRATEGY

AFGHANISTAN Weak Not Available Limited None Insufficient None None

BANGLADESH Moderate Not Available Partial Emerging Robust Published Published

CAMBODIA Good Available Limited Minimal Insufficient None Published

FIJI Good Not Available Not Available None Insufficient None Published

INDIA Good Available Comprehensive Established Robust Published Published

INDONESIA Good Available Partial Emerging Robust Published Published

JAPAN Excellent Available Comprehensive Established Robust Published Published

KAZAKHSTAN Good Not Available Comprehensive None Insufficient Published Published

KYRGYZ REPUBLIC Good Not Available Comprehensive Minimal Insufficient None None

MYANMAR Good Developing None Emerging Developing None Published

NEPAL Good Not Available Partial Minimal Robust Published Published

PAKISTAN Weak Available Partial None Developing Published Published

PHILIPPINES Good Available Partial Minimal Developing Published Published

SINGAPORE Excellent Available Comprehensive Established Robust Published Published

SRI LANKA Good Available Partial Minimal Robust None Published

TAJIKISTAN Limited Not Available Limited None Developing None None

THAILAND Excellent Available Partial Established Adequate Published Published

TIMOR-LESTE Limited Not Available Limited Minimal Insufficient None None

UZBEKISTAN Good Not Available Comprehensive None Developing None None

VIETNAM Excellent Available Partial Minimal Robust Published None

NOTES
This scorecard has been elaborated in the Annexure to this document.
Japan and Singapore are included here as high-income country (HIC) examples for comparative reference.

45
Advancing Telemedicine in Asia | 2024 Report
This resource has already identified significant
opportunities to advance telemedicine across
Asia. These range from leveraging emerging
technologies to fostering partnerships and
advocating for supportive policies.

The following sections expand on three of these

opportunities, highlighting illustrative areas for
technical assistance, such as capacity building
and further research, to help build toward these
larger opportunities.

47
 Opportunity #1
Innovative approaches
to implement
and expand telemedicine
in geographically
spread-out areas

Advancing Telemedicine in Asia | 2024 Report

 This document has already outlined some of the challenges faced in island
nations across the Asia–Pacific region (refer to Chapter 3, p.19). In
archipelago nations, such as Fiji, Kiribati, and the Philippines, telemedicine
emerges as a crucial solution for overcoming the obstacles of delivering
health care in geographically dispersed regions. Many remote
communities in these regions have limited access to specialized medical
care, underscoring the potential of telemedicine for remote consultations
and diagnostics.

Understanding the The hub-and-spoke model, a creative approach to telemedicine, not only
hub-and-spoke model corresponds with the geographical layout of these islands, where a central
island often acts as a hub with smaller surrounding islands, but also aligns
with traditional health care delivery mechanisms, with larger district and
specialty hospitals located in the central islands and health posts in the
smaller islands and islets (Figure 6). By leveraging existing technology or
available telemedicine platforms, health care providers can bridge this gap,
offering timely medical advice and treatment to remote patients, thereby
alleviating strain on health care facilities.

Illustrative areas of assistance could encompass supporting the

development of a roadmap and toolkit to identify potential hub-and-spoke
facilities, defining their roles, and developing a comprehensive toolkit. This
toolkit would provide guidelines for setting up telemedicine infrastructure,
protocols for patient care, and technical specifications for necessary
equipment, ensuring a streamlined and effective implementation process.

Figure 6. An illustrative depiction of a hub-and-spoke telemedicine model in Fiji

Advantages of the
Hub & Spoke Model
VANUA LEVU
Specialists from larger
health care facilities connect YASWAS
remotely with patients in
community clinics from
TAVEUNI
home.

Addresses shortages of
specialists, particularly
in remote areas.
VITI LEVU
Increases access to
specialty care while
improving efficiency
and cost-effectiveness.
LAU GROUP

KADAVU

49
 Opportunity #2
Integration of AI and
emerging technologies
in telemedicine

Advancing Telemedicine in Asia | 2024 Report

 The advancement of AI and the 5G technology presents an exciting
opportunity to enhance the effectiveness of telemedicine across Asia.
As discussed in Chapter 3 (p.27), deployed carefully with its inherent risks
in mind, AI holds significant potential as a layer to telemedicine. The
potential of 5G networks to host increasingly complex features in
telemedicine (highlighted in Table 2, p.19) further enhances the quality
of consultations, enabling real-time video conferencing and remote
monitoring of patients’ vital signs. Here, we expand on how AI offers
further potential in telemedicine across four key areas,
with considerations regarding tentative risk areas:

AI-powered diagnostic tools Remote monitoring and chronic disease

management
AI can analyze medical images, patient data,
and real-time video feeds, aiding health care AI can continuously monitor patients with chronic
providers in making accurate diagnoses remotely. conditions using data from wearable devices and
Additionally, AI can personalize treatment plans remote monitoring tools, ensuring timely follow-ups
based on the unique profiles of patients, optimizing and alerting health care providers to early warning
medical interventions. Addressing potential risks signs of disease progression. Mitigation strategies
such as biases in AI algorithms and ensuring should include continuous monitoring for accuracy
these tools are implemented in a rights-respecting and reliability, as well as protocols for responding to
way is crucial. false alarms

Patient engagement and support AI-driven clinical decision support

AI-driven technologies like virtual health assistants These tools can provide health care providers
and chatbots can enhance patient engagement by with evidence-based recommendations during
providing 24/7 access to information, scheduling teleconsultations, enhancing the quality of care
telemedicine appointments, and conducting initial delivered remotely. Regulation is necessary to ensure
patient assessments. Implementing these technologies they support rather than override clinical judgment
requires careful consideration of data privacy and and to mitigate the risk of erroneous
security to protect patient information. recommendations.

Once reliable connectivity, unique identity, DFS and DPI-H

are established, incorporating emerging technologies into telemedicine
platforms can significantly enhance health care delivery. Without this
enabling environment, the aforementioned AI use cases will remain siloed
in their deployment and potential impact. To realize the potential of AI in
telemedicine, illustrative areas of assistance may include creating
evaluation and funding mechanisms to encourage responsible innovation.

This will ensure high-impact AI applications in telemedicine are prioritized

and supported. Building a robust evidence base through research and
developing use cases can demonstrate the efficacy and benefits of AI in
remote health care, providing tangible examples for wider adoption.
Additionally, strengthening government and ecosystem capacity by
investing in AI research and development, training programs, and aligning
AI initiatives with government priorities can facilitate the integration of AI
into telemedicine funding plans, ensuring sustainable and effective
implementation.

51
 Opportunity #3
Leveraging community
health worker networks
in telemedicine

Advancing Telemedicine in Asia | 2024 Report

 Throughout Asia, a vast network of CHWs serves as the backbone of
primary health care services for rural and underserved communities.35
While their role in improving connectivity has been highlighted in Chapter 4,
their importance in delivery, particularly in assisted telemedicine, as
emphasized in Chapter 2 (p.7), cannot be overstated.

Equipped with digital skills, these CHWs can play a crucial role in improving
Pivotal role played by Community
Health Workers (CHWs) patient experiences by facilitating teleconsultations, providing basic and
specialized medical care, and educating patients on preventive measures.
By training CHWs to use telemedicine platforms, we can ensure that
patients in remote communities receive timely and appropriate medical
attention. This approach places the patient at the center of care, making
health care more accessible and personalized. This opportunity is mutually
beneficial, leveraging the strong presence and community engagement of
CHWs to enhance the reach and efficacy of telemedicine, while
telemedicine, in turn, empowers CHWs by improving their skills and
effectiveness Further this opportunity leveraged correctly has the potential
to strengthen the primary health care system by decentralizing care and
utilizing local resources effectively.

Illustrative areas of assistance could include establishing comprehensive

training programs to equip health care providers with the necessary skills
for effective telemedicine implementation, covering topics such as
teleconsultation protocols and patient communication strategies.
Additionally, designing and implementing action plans to integrate
telemedicine into the daily workflows of CHWs is crucial. Furthermore,
providing supportive supervision and mentorship mechanisms is essential
to offer ongoing guidance and assistance to CHWs in using telemedicine
technologies and addressing any challenges they encounter.

53
Advancing Telemedicine in Asia | 2024 Report
Conclusion
This resource serves as a guide to understanding
and advancing telemedicine across Asia.
From tracing its historical emergence to identifying
the technological and policy requirements for
its successful implementation, this resource
equips policymakers and stakeholders with the
necessary insights to drive meaningful change
in health care delivery.

By highlighting opportunities and mapping enablers

across the region, this study lays the groundwork
for scalable and impactful telemedicine initiatives.
While not exhaustive, it provides a roadmap for
further exploration and consideration, ensuring that
telemedicine interventions contribute lasting value
to both health care systems and individual
patients in Asia.

55
Advancing Telemedicine in Asia | 2024 Report
Annexure

57
 PARAMETER CONNECTIVIT Y PAYMENTS IDENTIFICATION

Scoring Country was given a score out of Availability of real-time payments Score out of 3 based on the status of
basis 300 based on 4 World Bank mechanism that is underpinned by their national ID (Digital Data, World
Indicators: an interoperability framework Bank)

• Individuals using the • Score out of 3 based on the

internet (% of total pop) + status of their national ID
(Digital Data, World Bank)
• Mobile cellular subscription
(per 100) + • Records are stored in a digital
format rather than in paper
• Fixed broadband records or ledgers.
connection (per 100) +
• Digital verification of identities
• Cost per MBPS and/or identity information.
For example, name, date of
birth, and other details can be
verified or authenticated using
digital rather than manual
means in the context of
in-person transactions.

• Online digital identity can be

used to access online services
and transactions. This means
digital credentials provide the
ability to securely authenticate
identities remotely.

Excellent: ≥ 250 Available 3

Good: 175–249.99 2

Moderate: 125–174.99 1

Weak: ≤ 124.99 Not Available 0

Advancing Telemedicine in Asia | 2024 Report

DPI-H LEGAL & SECURIT Y TELEMEDICINE P OLICY DIGITAL HEALTH STRATEGY

Score out of 3 based on the Country was given a score Public availability of a Public availability of a national
status of the availability of the out of 4 based on the status national telemedicine policy, telemedicine policy, guideline,
following interoperable blocks: of the availability of the guideline, or government or government notification
following publicly available notification
• Digital registries policies:

• EHR
• A digital data security
• Health interoperability or act
exchange
• An infrastructure
technology act

• Drug prescription
regulation

• A national digital
architecture

3 3 Published Published

2 2

1 1

0 0 Not Published Not Published

59
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