World Health Organization · 1st edition, 2022 · 68 pages
A step-by-step guide for policy-makers and implementers to plan, deploy, and sustain telemedicine services within national health systems.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2022
- Audience
- Policy decision-makers, programme managers, health administrators, digital health coordinators, implementers responsible for telemedicine design and oversight
- Evidence
- Consolidation of WHO recommendations (2019 GRADE-rated digital health guidelines), expert consensus, case studies, and operational guidance from COVID-19 response
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guide consolidates best practices and guidance for implementing telemedicine services, defined as the delivery of health-care services where distance is a critical factor, using information and communication technologies. Building on WHO’s 2019 digital health recommendations and lessons learned during the COVID-19 pandemic, the guide provides a systematic 11-step framework organized in three phases: situational assessment, implementation planning, and monitoring and evaluation.
The guide emphasizes that telemedicine must complement—not replace—in-person care, and be implemented where patient safety, privacy, traceability, accountability, and security can be monitored. It covers both client-to-provider (patient-to-health worker) and provider-to-provider telemedicine, delivered through synchronous (real-time video/audio), asynchronous (store-and-forward), or remote monitoring modalities. Key implementation considerations include establishing governance structures, ensuring regulatory frameworks, training health workers, protecting data privacy, verifying provider credentials, addressing equity and accessibility (including for persons with disabilities), and planning for sustainable financing and integration into routine health service delivery.
The document includes case studies from India (eSanjeevani national service with over 50 million consultations), Cabo Verde (archipelago-wide specialist access), Indonesia (sexual and reproductive health via WhatsApp), Qatar (mental health helpline), and Mali (remote ultrasonography supervision). These examples illustrate diverse use cases, technological approaches, and solutions to common challenges such as connectivity limitations, health worker resistance, data security, and ensuring equity of access.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Client-to-provider telemedicine should complement, not replace, face-to-face services and requires SOPs for patient consent, data protection, and provider credential verification (WHO recommendation).
- Provider-to-provider telemedicine is recommended where patient safety, privacy, traceability, accountability and security can be monitored through established SOPs.
- Telemedicine for medical abortion services can be offered as an alternative to in-person interactions for eligibility assessment, counselling, medication administration instructions, and follow-up care.
- Establish clear consent documentation, including verbal or text-recorded consent for health worker-initiated telemedicine and consent for how health information data will be stored.
- Implement mechanisms to verify licensing and accreditation of health workers, with display of registration numbers prior to clinical consultations and redressal mechanisms for fraud.
- Ensure accessibility for persons with disabilities through screen reader compatibility, captioning, volume control in videoconferencing, and text-to-speech generators.
- Develop budgets covering all implementation phases: development and set-up, deployment, integration and interoperability, scale-up, and sustained operations including software maintenance and hardware replacement.
- Monitor key indicators including percentage of health services performed using telemedicine, percentage of scheduled appointments completed, time required to obtain service versus non-telemedicine, and patient/health worker satisfaction levels.
Illustrative cost categories for patient-to-health worker telemedicine
Table extracted from the guideline
| Cost category | Description |
|---|---|
| Governance (Ongoing) | Personnel for partnership-building, coordination meetings, governance body for standards and interoperability |
| Management and staffing (Ongoing) | Personnel for programme oversight, clerical staff for call triage, clinical staff for consultations, access to specialists, monitoring, system support |
| Outreach and awareness (Development) | Development and dissemination of materials on accessing intervention via pamphlets, social media, health facilities |
| Technology adaptation (Development) | Software customization for communication channels, security features, cloud-based encrypted solutions for remote monitoring |
| Equipment/hardware (Deployment) | Computer with audio/video software, conferencing equipment, headsets, trunk lines, authorized medical devices |
| Initial training (Deployment) | Development of training protocols and SOPs including call intake, consent, referral processes, training end-users |
| Technology integration (Integration) | Architecture design to link with other interventions, software customization, additional personnel for interoperability |
| Training and adaptive management (Scale) | Additional training for health workers, supervisory personnel, ICT support staff, periodic review meetings |
| Communication/data exchanges (Sustained) | Airtime and data transmission costs, toll-free provisions, support line for feedback |
| Technology maintenance (Sustained) | Software maintenance and licence fees, hardware maintenance, insurance, repair/replacement |
Source: World Health Organization, Consolidated telemedicine implementation guide. Reproduced in summary form.
From the guideline
Verbatim
“WHO recommends the use of client-to-provider telemedicine to complement, rather than replace, the delivery of health services and in settings where patient safety, privacy, traceability, accountability and security can be monitored.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As WHO consultant and Chair of the Public Health Institute of Georgia, I see this consolidated guide as particularly timely for our region's ongoing digital health transformation. Georgia's eHealth infrastructure and universal health coverage framework since 2013 provide the necessary foundation, but we must now address regulatory gaps—specifically adapting medical licensing regulations to permit cross-jurisdictional telehealth practice across our 11 regions and developing clear reimbursement mechanisms within the State Healthcare Programme. The case studies from archipelago nations like Cabo Verde offer direct lessons for our mountainous terrain where 30% of the population lives in rural areas with limited specialist access. I would emphasize to Georgian clinicians the guide's stress on complementarity—telemedicine as an adjunct, not replacement, for physical examination—and the necessity of robust consent and data protection SOPs given our obligations under both national law and EU approximation processes. The realistic caveat is workforce capacity: our rural ambulatories already face staff shortages, and adding telemedicine responsibilities without addressing workload, remuneration adjustments, and reliable technical support risks health worker burnout and programme failure, as several pilot projects in Kakheti and Samegrelo have demonstrated.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, this guide provides a framework particularly relevant for addressing geographic barriers in mountainous areas and improving specialist access in rural regions. Georgia’s existing digital health infrastructure, including the eHealth system implemented since 2015, provides a foundation for telemedicine integration. National programmes would need to consider regulatory adaptation of existing health worker licensing frameworks to accommodate cross-regional practice, integration with the universal health coverage programme (operational since 2013) to ensure reimbursement mechanisms, and addressing connectivity disparities between urban centers like Tbilisi and remote areas in Racha, Svaneti, or Adjara. Attention to equity considerations for elderly populations, ethnic minorities, and persons with disabilities would be essential, alongside capacity-building for health workers in rural health posts and family medicine ambulatories to utilize telemedicine for specialist consultation and continuing education.
Questions this guideline answers
Quick answers
What types of telemedicine services does WHO recommend?
WHO recommends both client-to-provider (patient-to-health worker) and provider-to-provider telemedicine where patient safety, privacy, traceability, accountability and security can be monitored. This includes synchronous services (real-time video/audio), asynchronous store-and-forward (images/data for later analysis), and remote patient monitoring using connected medical devices. Telemedicine should complement, not replace, face-to-face services.
What are the essential elements of standard operating procedures for telemedicine?
SOPs must cover: patient consent procedures including consent for data storage and potential recording; verification of health worker licensing and credentials; data protection and privacy protocols; clear identification confirmation of both patient and health worker; clinical protocols defining what requires face-to-face contact; training on technology use and clinical adaptations; and referral pathways for diagnostic tests, medications, and in-person follow-up.
How should patient data privacy and security be protected in telemedicine?
Develop a data security plan for storing, transferring and processing health information with clear authorization levels. Use public key encryption for sensitive data, establish responsibility for data breaches, provide secure environments (closed rooms) for consultations, determine policies for connected medical devices and personal device use, ensure WHO-ITU accessibility standards compliance, and implement audit mechanisms. Screenshots or recordings require explicit patient consent and secure archival.
What costs should be included in telemedicine budgets?
Budgets must cover: governance (coordination meetings, standards oversight); management and staffing (clinical staff, specialists, support personnel); technology (software customization, security, maintenance, licenses); equipment (computers, conferencing hardware, medical devices, repairs); training (initial and refresher); outreach and awareness campaigns; communication/data costs; and integration with health information systems. Plan across all phases from development through sustained operations, not just initial capital expenditure.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
ASF accreditation standards
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- Issuer
- World Health Organization
- Type
- Publication
- Edition
- 1st edition, 2022
- Status
- Current
- Published
- 2022-11-09
- Languages
- English
- Scope
- Global, all health programmes and levels of care
- Audience
- Policy decision-makers, programme managers, health administrators, digital health coordinators, implementers responsible for telemedicine design and oversight
- Pages
- 68
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978 92 4 005918 4
- Evidence
- Consolidation of WHO recommendations (2019 GRADE-rated digital health guidelines), expert consensus, case studies, and operational guidance from COVID-19 response
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
World Health Organization. Consolidated telemedicine implementation guide. Geneva: World Health Organization; 2022. 68 p. ISBN 978-92-4-005918-4.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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