Telemedicine is not new. As is the case for many innovations, it has taken decades for telemedicine to enter the mainstream as a health care delivery system. Even today, in economically developed countries, the percentage of patients receiving their health care by telemedicine is relatively small although there are exceptions. For example, inmates in correctional facilities in certain jurisdictions in the United States are heavy users of telemedicine services. In some rural communities, nearly all hospital-based radiology imaging is done by teleradiology. There is a growing number of successful telepsychiatry and teledermatology practices in the United States. Many other subspecialties are having their successes as well.

Implementation of telemedicine in unique environments can present special challenges. The multi-author book, “Establishing Telemedicine in Developing Countries: From Inception to Implementation”, touches many factors that may be unique to developing countries. However, the main theme is the state-of-the-art in telemedicine. The volume is based, in part, on the presentations at the First Intensive Balkan Telemedicine Seminar, held in Prishtina, Kosova, 25-27 October, 2002. Topics ranged from telemedicine applications, including robotic surgery and home health, to telemedicine and telehealth economics.

The books' editor, Dr. Rifat Latifi, is a brilliant academic surgeon who played a key leadership role in implementing telemedicine in Kosova. Currently, he practices surgery in Arizona. Dr. Latifi is attuned to factors that affect the sustainability of telemedicine programs and he understands the differences between health care systems in economically developed countries and in developing countries. He is also a technophile who correctly sees innovation as a cornerstone to future improvements in health care for his patients. To some extent, this book reflects his interests and priorities, and these are rock solid.

The book consists of 26 chapters by international experts in a number of fields. Dr. Latifi encouraged the authors to be forward thinking and they have responded well to this challenge. The chapters present a broad vision of the future of health care as pictured by individuals who understand the potential importance of information technologies, telecommunications, and robotics as enabling and transforming technologies for health care.

Whereas the book's title indicates a focus on establishing telemedicine in developing countries, the authors often paint their pictures with somewhat broader strokes. From the perspectives of this book and it's editor, all countries are “developing countries” with respect to telemedicine. Although there is a world of difference between economically developed countries with fully functional health care delivery systems and those with little or no health care infrastructure, no country can fully leverage the power of computers, information technologies, telecommunications, and robotics, at this point in time. Today's rapid rate of innovation precludes health care systems from catching up with the state-ofthe- art in technologies. Even in economically developed countries, health care systems have gaps between system-wide implementations of technologies and the promising technologies that are in the pipeline for future implementation. Latifi's “developing countries” are, in some ways, a metaphor for twenty-first century health care systems everywhere. There will always be gaps between what visionaries foresee and what exists today. Latifi's edited volume underscores this disparity and showcases a glimpse into the future. These progress reports are informative and often thought provoking. Hopefully, the developing countries as well as the underdeveloped nations will be among the beneficiaries of these inspirations and visions.

Ronald S. Weinstein, M.D.

President, American Telemedicine Association