Available via license: CC BY-NC 4.0
Content may be subject to copyright.
I. Introduction
In late May 2015, there was an outbreak of the Middle East
respiratory syndrome corona virus (MERS-CoV) that spread
widely among the hospitals in the metropolitan area of
Seoul, Korea. Infected patients were placed in isolation hos-
pitals, and patients who had contracted or were suspected to
have contracted the MERS-CoV were isolated in their homes
or medical facilities for a set duration. By the end of July,
there were 186 conrmed cases of the infection and 16,600
people had been placed in isolation [1].
In the process, large domestic tertiary care hospitals be-
came major sources of MERS-CoV infection, and the gov-
ernment allowed telemedicine to treat the patients of those
Prerequisites for Effective Implementation of
Telemedicine: Focusing on Current Situations in
Korea
Hyeoi-Yun Lee, MSN, RN, Ji-San Lee, MSN, RN, Jeongeun Kim, PhD, RN
College of Nursing, Seoul National University, Seoul, Korea
Objectives: e practice of telemedicine requires social interventions and systems for ecient implementation. Further, it
requires sucient discussions among related parties because the purpose of telemedicine is diagnosis and treatment, and the
participation of medical specialists is essential. Based on the characteristics of the healthcare structure of Korea, which has a
low proportion of public healthcare and most patients are taken care of by a few large tertiary care hospitals, the fundamental
issues need to be discussed. Methods: A comparison was conducted with overseas cases to discuss the prerequisites for the
eective implementation of telemedicine in South Korea under the current situation. We also examined the structural char-
acteristics of the Korean medical community. Results: e current paper recommends that an in-depth analysis and studies
are conducted on the following aspects: a search for telemedicine services focused on public healthcare, a search of services
for illnesses that impose high levels of burden on households, and the development and implementation of a telemedicine
system for follow-up management at primary and secondary care hospitals aer the patient undergoes surgery or treatment
at tertiary care hospitals. Conclusions: As the technology develops, the focus should also be on factors such as safety, useful-
ness, availability, and how the functions will be realized in order to enable user communication. A clear system should be
established to regulate and manage the lack of sucient discussions. In addition, seeking projects and systems that reect the
characteristics of each country will facilitate the ecient implementation of telemedicine.
Keywords: Telemedicine, Telehealth, Health Policy
Healthc Inform Res. 2015 October;21(4):251-254.
http://dx.doi.org/10.4258/hir.2015.21.4.251
pISSN 2093-3681 • eISSN 2093-369X
Review Article
Submitted: August 8, 2015
Revised: September 20, 2015
Accepted: September 21, 2015
Corresponding Author
Jeongeun Kim, PhD, RN
Research Institute of Nursing Science, College of Nursing, Seoul
National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
Tel: +82-2-740-8483, Fax: +82-2-766-1852, E-mail: jeongeunkim
0424@gmail.com
This is an Open Access article distributed under the terms of the Creative Com-
mons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduc-
tion in any medium, provided the original work is properly cited.
ⓒ 2015 The Korean Society of Medical Informatics
Reviewed
January
February
March
April
May
June
July
August
September
October
November
December
252 www.e-hir.org
Hyeoi-Yun Lee et al
http://dx.doi.org/10.4258/hir.2015.21.4.251
hospitals through the telephone for a limited time without
sufficient consideration of the policy debate and prior re-
search, which became controversial subjects.
While there are loose restrictions on the scope and criteria
for factors such as the target service base, standards, techni-
cal forms, and implementation of e-health and u-health, the
practice of telemedicine requires social interventions and
systems for efficient implementation. Further, it requires
sucient discussions among related parties because the pur-
poses of telemedicine are diagnosis and treatment, and the
participation of medical specialists is essential.
erefore, a comparison was conducted with overseas cases
to discuss the prerequisites for the eective implementation
of telemedicine in Korea under the current situation. We
also examined the structural characteristics of the Korean
medical community.
II. The Current Domestic and International
Status of Telemedicine
Telemedicine is a type of healthcare that provides medical
services to patients in distant locations and checks the pa-
tients’ conditions by means of communication modes such
as telephones, radios, and video calls.
Telemedicine began with the purpose of solving public
health problems in locations with inadequate professional
medical services, and it was intended to increase medical ac-
cess in countries with relatively large territories. erefore, a
variety of services that combine information and communi-
cation technology have been and are being developed. Re-
cently, research on and the implementation of telemedicine
has also been conducted in the Middle East and Africa,
where the medical industry is relatively underdeveloped, to
resolve inequalities in access to medical benets.
With reference to reviewing the status of policies and tech-
nical introduction of telemedicine in foreign countries, the
United States started to discuss policies focused on securing
health rights in medically vulnerable areas and develop-
ment of the healthcare industry since the establishment
of the American Telemedicine Association in 1993. Later,
Electronic Health Record (EHR) systems were established,
portals for telemedicine practice of Medicare and Medicaid
were launched, inventories were built for emergency situ-
ations and disaster medical response, and their efficiency
was evaluated [2]. Currently, the United States implements
telemedicine services, such as remote consultation and in-
dividual psychotherapy, with Medicare and Medicaid, and
insurance benets are provided for the elderly aged 65 years
and over. Telemedicine thus carries the same responsibilities
as face-to-face medical care.
Canada, with an implementation plan for medical informa-
tization by the end of the year 2000, established businesses
to build the EHR system and supplying programs. Currently,
telemedicine is being utilized for psychotherapy and oncol-
ogy, and 21% of the total population is using telemedicine
for a majority of actual medical treatments (73%) [3].
In Europe, telemedicine is implemented focusing on home
healthcare management in countries with a rapidly aging
population, and service conveniences are considered by
computerizing and putting medical systems of all member
countries online. Further, the compatibility of the medi-
cal systems of each country is being worked on. England
has promoted medical informatization since 1986. It began
the Choose & Book reservation system in 2004 and a full
prescription service in 2005 [4]. Australia began providing
telemedicine services at the beginning of the 20th century.
It continues to expand because of the diculties of directly
delivering medical care due to the country’s vast territory.
Further, in 1996, the Australia & New Zealand Telehealth
Committee was established with New Zealand to deliver
health and medical information and services [2].
In Japan, medical treatments and surgeries are performed
under teleradiology and telepathology with the advice of
doctors (medical facilities) and medical specialists, which al-
lows for observations, health instructions, and advice to pa-
tients. Additionally, long-term care insurance pays the costs
for these services [4].
In Korea, a telemedicine pilot project, which utilized vital
signs and electrocardiograms, has been conducted for rural
areas and army medical corps since 1990. In 2002, there was
an attempt to institutionalize telemedicine by revising the
medical laws, and a pilot project was carried out in some
districts and islands [5]. Its eectiveness is being evaluated
through a telemedicine pilot project between medical doc-
tors and patients that began in September 2014 [6].
III. Current Challenges
In other countries, when implementing telemedicine, along
with technical development, efficient settlement was pro-
moted by discussing the structure of the medical industry
and health policy of each country from the planning stage.
However, research in Korea has been relatively biased toward
the technical aspects. This is partly due to disagreements
between the medical community and government offices
with regard to policies for telemedicine practice. In 2010, the
Ministry of Health and Welfare pushed for a law amendment
to allow the practice of telemedicine between healthcare
253Vol. 21 • No. 4 • October 2015 www.e-hir.org
Prerequisites for Effective Implementation of Telemedicine
providers and patients, but it failed due to delays caused by
opposition from concerned organizations. At that time, the
government’s consideration was focused on the economic
aspects rather than people’s health. Moreover, the medical
community, such as the Korean Medical Association, was
worried about the ocking of patients to tertiary-care or for-
prot hospitals, so-called problems of healthcare privatiza-
tion and medical insurance costs, as well as system stability.
The Institute for the Future of State stated that because
previous studies on telemedicine mostly focused on the ef-
fectiveness and legitimacy of telemedicine, evaluations of
practical problems were insucient [7]. is means that un-
less there are sufficient discussions on costs and insurance
fees, system stability, countermeasures for healthcare respon-
sibilities and legal issues, and solutions for patient ocking
to specic medical facilities or doctors, the implementation
of telemedicine may be dicult. Based on the characteristics
of the healthcare structure of Korea, which has low a propor-
tion of public healthcare and most patients are taken care of
by a few large tertiary care hospitals, the fundamental issues
presented above need to be discussed.
IV. Suggestions
e structural and political discussion to address the current
contextual state of domestic telemedicine will take a long
time. erefore, we recommend that in-depth analysis and
studies are conducted on the following aspects. Additionally,
solutions for the current situation are presented.
First, a search for telemedicine services focused on public
healthcare is needed A ratio of medical professionals in Ko-
rea was 2.2 per 1000 people in 2014, which is lower than the
average of 3.3 in major OECD countries. Furthermore, the
number of nurses was 5.6, which is signicantly lower than
the OECD average of 9.1 [8]. In addition, due to the geo-
graphical concentration of medical facilities, primary medi-
cal facilities focusing on accessibility are also concentrated in
areas with high population density. erefore, several areas,
such as mountainous areas and islands, continue to lack
sufficient medical facilities. This proves the need for tele-
medicine systems focusing on public healthcare. e current
pilot project is limited to health consultations. erefore, the
expansion of service content that meets the needs of the do-
mestic situation is necessary.
Second, a search of services for illnesses that impose high
levels of burden on households is necessary. Among the na-
tional healthcare expenditures, households pay 37.7%, which
is 1.9 times higher than the OECD average of 19.5% [8].
erefore, an increase in the proportion of public healthcare
expenditure and a reduction in the proportion of self-pay
must be achieved by seeking a telemedicine system that is
suited to the severity and duration of costly illnesses, such
as circulatory diseases and malignant neoplasms [9], and
by expanding pilot projects that reflect the characteristics
of the local community through public healthcare facilities.
Furthermore, current projects organized by the Ministry of
Health and Welfare, which account for a large proportion
of the budget, such as antismoking campaigns, nutrition
education, and education on adult disease prevention [10],
are areas that have the highest inuence on the prevalence of
illnesses and on public health; therefore, preferential applica-
tions of telemedicine should be considered.
Third, we recommend the development and implementa-
tion of a telemedicine system for follow-up management
at primary and secondary care hospitals after the patient
undergoes surgery or treatment at tertiary care hospitals.
Even though the number of domestic cancer survivors has
surpassed one-million due to the development of medicine,
healthcare problems such as complication management, pre-
vention of secondary cancer, and management of chronic
diseases and psychosocial issues are challenges that still need
to be tackled [11]. To solve such problems, many domestic
and American studies and organizations have proposed the
‘shared care model’ in which cancer specialists and primary
care doctors take care of cancer patients together by sharing
information about the patient [12]. However, communica-
tion between cancer specialists of tertiary care medical fa-
cilities and doctors at the primary and secondary hospitals
is not easy to establish due to geographical and institutional
problems. Therefore, we hope that medical personnel on
both sides will contribute to reducing death rates and im-
proving the quality of life of cancer survivors by communi-
cating remotely, as a solution to this challenge.
In addition, application targets and methods that reflect
the characteristics of illnesses that occur in Korea need to be
selected.
V. Conclusion
Telemedicine is not an auxiliary method to simply replace
face-to-face medical care. It is a medical domain and an un-
avoidable phenomenon that must be developed in accordance
with the times. erefore, we have to keep pace with trends
in technology and institutions. e measurement of health
indices using smart devices is already actively practiced in
both Korea and overseas, and utilizing them in actual medi-
cal care can be easily accomplished with the current level of
technology. However, alongside technical development, the
254 www.e-hir.org
Hyeoi-Yun Lee et al
http://dx.doi.org/10.4258/hir.2015.21.4.251
focus during the development of telemedicine should also be
on factors such as safety, usefulness, availability, and how the
functions will be realized to enable user communication.
e rise of the necessity of telemedicine in radiation danger
zones aer the large earthquake in Japan in 2011 and discus-
sions on the application of telemedicine due to the spread of
MERS-CoV can be a temporary driving force for the devel-
opment and growth of related systems. However, the lack of
sucient discussions is a concern.
Korea is now at the stage to start providing telemedicine
services at the national level. erefore, without these fun-
damental discussions, only for the purpose to meet the
worldwide trend it will be dicult to successfully implement
telemedicine systems.
In the study of 2005 about the implementation of tele-
medicine services, the main factors associated with partial
failure of service were lack of needs-driven planning and
commitment to provide the service [13]. Therefore, as the
technology develops, a clear system should be established to
regulate and manage it. In addition, seeking for projects and
systems that reect the characteristics of Korea will facilitate
the ecient implementation of telemedicine.
Conflict of Interest
No potential conflict of interest relevant to this article was
reported.
References
1. Korea Centers for Disease Control & Prevention. MERS
statistics [Internet]. Sejong, Korea: Korea Centers for
Disease Control & Prevention; 2015 [cited at 2015 July
25]. Available form: http://www.mers.go.kr/mers/html/
jsp/Menu_C/list_C4.jsp?menuIds=&d=5767&q_type=
&q_value=&cid=64414&pageNum=.
2. Kim CL. America, Australia, South Korea 'telemedicine'
case studies comparative analysis. Proceedings of 2014
World Conference for Public Administration; 2014 Jun
25-27; Daegu, Korea. p. 30.
3. Organisation for Economic Co-operation and Develop-
ment. OECD Internet economy outlook 2012 [Internet].
Paris: Organisation for Economic Co-operation and
Development; 2012 [cited at 2015 Oct 4]. Available
from: http://www.oecd.org/sti/ieconomy/oecd-internet-
economy-outlook-2012-9789264086463-en.htm.
4. e u-Healthcare industrial market and company analy-
sis. Seoul, Korea: Korea Medical Device Policy Develop-
ment Institute; 2012.
5. Korea Ubiquitous-Health Association The current
state of telemedicine introduction of doctor-patient
[Internet]. Seoul, Korea: Korea Ubiquitous-Health
Asso cia tion; 2013 [cited at 2015 Oct 1]. Available from:
http://www.u-health.or.kr/information/sub01.php?tid=
21&nd_method=&nd_str=&uid=628&mode=view.
6. Korea Ministry of Health & Welfare. Telemedicine pilot
project demonstrated the number of participating or-
ganizations target application [Internet]. Sejong, Korea:
Ministry of Health & Welfare; 2014 [cited at 2015 Oct
1] Available from: http://www.mw.go.kr/front_new/
al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=
0403&CONT_SEQ=307484&page=1.
7. Kim YN, Park JH. Proposal for a strategic approach and
solve problems of telemedicine [Internet]. Daegu, Korea:
e Institute for the Future of State; 2014 [cited at 2015
Oct 1] Available from: http://www.ifs.or.kr/modules/
board/bd_view.asp?no=151&ListBlock=&gotopage=
1&Pagecount=1&sk=bd_title&sv=%BF%F8%B0%DD%
C0%C7%B7%E1&id=research&ca_no=&mncode=&le
=&top=&author=&top=2.
8. Organisation for Economic Co-operation and Devel-
opment. OECD health statistics 2015 [Internet]. Paris:
Organisation for Economic Co-operation and Develop-
ment; 2015 [cite at 2015 Oct 1]. Available from: http://
www.oecd.org/els/health-systems/health-data.htm.
9. Seo NK, Ahn SJ, Hwang YH, Kim JH, Kim CH, Bea
SK, et al. Healthcare in Korea at Korea Medical Panel
(2008–2012). Seoul, Korea: National Health Insurance
service; 2014.
10. Kim HL, Yeo JY, Jung ES. Current situation and im-
provement of the national health fund projects. Seoul,
Korea: Korea Institute Health and Social Aairs; 2013.
11. Lee JE, Shin DW, Cho BL. e current status of cancer
survivorship care and a consideration of appropriate
care model in Korea. Korean J Clin Oncol 2015;10(2):
58-62.
12. Oenger KC, McCabe MS. Models for delivering survi-
vorship care. J Clin Oncol 2006;24(32):5117-24.
13. Brebner JA, Brebner EM, Ruddick-Bracken H. Experi-
ence-based guidelines for the implementation of tele-
medicine services. J Telemed Telecare 2005;11 Suppl 1:3-5.
