The broad reach of telemedicine was put on full display during Sunday's 2011 International Telemedicine Forum.

The two-hour session, one of several held in advance of Sunday evening's official opening of the ATA 2011 conference, highlighted telemedicine projects in four nations – Australia, Brazil, India and China – and introduced five more to the ATA's international fold. It also gave ATA officials a chance to point out the value of those projects to America's changing healthcare landscape.

"This is a time … where we do have to work together more than any other time," said ATA President Dale Alverson in opening the session. "We are in a major transition in the United States with healthcare reform."

Alverson pointed out that the United States spends more on healthcare than any other nation, yet doesn't get good results. "That's why we need to learn from you," he told an audience of about 100 attendees.

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Alverson was followed by Ana Lucia Ruggiero, a specialist for knowledge transfer with the Pan American Health Organization, which covers 37 countries in Central and South America – 35 of which are working on an e-Health platform. Ruggiero referenced a recent World Health Organization survey on telemedicine which indicated cost and infrastructure are the primary barriers in developing nations, whereas legal issues over the protection of data and a perception of need are the main hindrances in developed countries.

Telemedicine initiatives in any country, Ruggiero said, need to develop realistic objectives, rather than setting goals that can't be reached. They need to focus on simple solutions first, she said, and take advantage of partnerships and alliances, both private and public.

Examples of successful telemedicine programs were offered by officials from four nations. In Australia, a $467 million pledge from the government following the 2010 national elections is helping to develop a network of teleconsulting stations linking patients to specialists through their primary care providers.

"In the newspaper, you can see telemedicine everyday," said Yogesan Kanagasingam, PhD, MSc, director of the Australian e-Health Research Center and president of the Australasian TeleHealth Society. He said teleradiology and mental health are the most popular uses for telemedicine in a nation where major population centers are sometimes thousands of miles apart, and current pilot projects are targeting eye care, COPD, rehabilitation services and cervix cancer screening.

In Brazil, a federally funded telehealth program launched in 2007 has established telemedicine services in nine states, covering some 1,200 cities. The program creates "family health teams" of physicians and associated caregivers, who work through family practices, according to Alexandre Taleb, MD, head professor of the Telemedicine and Telehealth Department Medical School at the Universidade Federal de Goias in Brazil and state coordinator of the Brazilian National Telehealth Program.

Taleb said Brazilian officials are looking to connect the entire country to telemedicine resources by the end of 2012.

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India's Apollo Telemedicine Networking Foundation, launched in 1999, is seen by many experts as a global leader in the telemedicine movement. Its president, Krishnan Ganapathy, PhD, MS, FACS, FICS, FAMS, who is also president of the Telemedicine Society of India, said "telemedicine is slowly becoming part of the vocabulary of the Indian citizen," but it still suffers from the perception that healthcare delivered over a distance isn't as good as a face-to-face meeting with a doctor.

Ganapathy said India is using its telemedicine resources to improve awareness of drug interactions and to educate physicians. He also pointed to the cellphone – 725 million of which are now in use in India – as the key to healthcare delivery in the future.

He also chided President Barack Obama for a recent reference to Americans seeking "cheap healthcare" in India.

"We have the technology, we have the interest, we have the knowledge, and perhaps we can even get the funding," he said.

Also presenting was Liu Yong, MD, chairman of China's Sunpa Telemedicine. Created in 1998, Sunpa has created what is considered to be one of the largest telemedicine networks in the world, connecting more than 1,000 hospitals and 50,000 physicians to 460 million people in and around Beijing, Shanghai, Guangzhou and Kunming. The company has also developed more than 80 telemedicine systems and devices and hundreds of software products.

The session concluded with a signing ceremony for the ATA's new MoU partners – the eHealth Association of Pakistan, the Telemedicine Society of India, the Armenian Association of Telemedicine, the UK's Telecare Services Association and the Telemedicine Society of Nepal.

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