# Abstract E-health (information and communication technology that facilitates health and health care) is expanding in developed, developing, and least-developed countries. E-health’s ability to transcend sociopolitical boundaries holds the potential to create a borderless world for health systems and health care delivery. But the policy needed to guide e-health development is limited and just now emerging in developed countries. What’s needed to ==foster e-health growth in the developing world is thoughtful policy to facilitate patient mobility and data exchange, across both international borders and regional boundaries within countries==. # Introduction In the developing world, policy makers face critical challenges as they attempt to develop borderless2 e-health policy3 amid competing demands on funds and resources. This risks further broadening the “digital divide”—the longstanding gap between those with and without access to electronic information and communication. In the developing world, policy makers face critical challenges as they attempt to develop borderless2 e-health policy3 amid competing demands on funds and resources. This risks further broadening the “digital divide”—the longstanding gap between those with and without access to electronic information and communication. Developing countries need assistance to establish policy and strategies to address their own needs. At the same time there should be a global approach that facilitates telehealth and health informatics applications. This paper presents the current state of e-health policy globally, and argues for “glocal” e-health policy—policy that engages the wisdom and experience of stakeholders at the global and local levels. The current parochial, nation-centric approach threatens to create permanent e-health silos, negating the potential benefits of e-health in a borderless global environment. # Legislation And Global E-Health MALAYSIAN TELEMEDICINE ACT. Malaysia is one of the few countries with specific e-health legislation, including the Laws of Malaysia, Act 564, the Telemedicine Act of 1997. The act “provides for the regulation and control of the practice of telemedicine; and for all matters connected therewith.” INDIA. In India, policy makers are considering ehealth laws35 that address current limits to international practice of telemedicine across borders. Options being considered are as follows: (1) mutual recognition between countries for the medical license granted by a physician’s home country; (2) reciprocity between countries to allow licensed doctors to practice via e-health in both countries; (3) registration, which would ensure that physicians are liable under medical negligence and malpractice laws in the country where the e-health patient resides or communicates from; (4) limited licensure, an arrangement that allows a physician to obtain limited licensure through a licensed referring doctor in the country where the e-health patient resides or communicates from. WORLD MEDICAL ASSOCIATION Policies developed by this group over several years36 reflect the tension between ideal goals and technical limitations and reflect how e-health policy development is complex and evolving. The group’s 2007 “Statement on the Ethics of Telemedicine”37 addresses data security: “The physician must aim to ensure that patient confidentiality and data integrity are not compromised. Data obtained during a telemedical consultation must be secured through encryption and other security precautions must be taken to prevent access by unauthorized persons.” However, this language raises new questions: Do digital telephones transfer or transmit data, and what of videoconferenced teleconsultations? | Challenges Facing Information and Communication Technology And E-Health Policy Makers in Developing Countries | | ------------------------------------------------------------------------------------------------------------- | | Weak strategic planning | | Resistant to change | | Lack of human resources at all levels | | Inadequate funding | | Limited experience with complex technology implementation | | Undue influence of vendors | | Changing priorities | | Lack of integration between departments and ministries | | Lack of information sharing between agencies | | Lack of data collection and interpretation culture | | Technophobia | | Weakness in the conceptualization of the e-health framework | | Emerging cultural challenges | # Conclusion The full potential of global e-health to meet both national and global health objectives is not being tapped. This will remain the case until a conducive environment and appropriate global ehealth policy are in place. An initiative begun by the Rockefeller Foundation to establish a global e-health convention may establish the required awareness. In defining appropriate e-health policy—applying an expansive interpretation of what constitutes “policy” (legislation, strategic plan, roadmap, or action plan)—it would appear that about half of the world’s nations have some form of e-health policy but little commonality in what they aim to achieve. ==Attention needs to be directed toward policy issues that will enable and facilitate patient mobility, data mobility, and sharing, across both international borders and regional boundaries within countries==. Developing countries already find themselves disadvantaged from the standpoint of access to information and communication technology, human resource capacity, and economic capacity. They require assistance with developing relevant of e-health strategies and policies that fit their needs and infrastructures, and which will also allow for cross-border e-health. Failing this, there is a real danger that developing countries will be unable to obtain much-needed international e-health support (for example, telemedicine services). When viewed from a global perspective, ehealth policy is being formulated in a parochial manner as nations, states, and regions introduce e-health policies that meet only their own needs. Such national and local e-health policies may entrench a silo mentality in e-health, so that instead of e-health leading to a borderless global environment,1 the developing world will be further isolated from the international benefits of global e-health. That would be a tragedy especially since the world has so much opportunity at the moment to get these policies right.