Madam, Telecommunication industry has been amongst one of the most successful industries in our country and is ranked 9th internationally in terms of growth.  We would like to draw your attention towards the immense potential telecommunication holds for medical practice. Telemedicine is a term which was introduced first in 1970\\\'s and literally means "healing at a distance".¹ This is done either in real time with a webcam and a software for transmission of information (synchronous method) or via email or other modes of communication (store and forward or asynchronous). It aims to provide expert medical consultation without any regards to the distance between the doctor and the patient. This is applicable in situations where clinics serving in rural areas need expert consultation from doctors operating in hospitals in urban centres.^2,3 Other applications of telemedicine include remote clinical care and follows ups, administrative management, CME training for doctors and paramedics and disaster management.
Pakistan has one physician for 1,351 people, one dentist for 20,000 people and single pharmacist for 20,000 people. The initiatives taken by PAKSAT-HEALTHNET and COMSATS to combat this giant problem cannot be overlooked. COMSATS institute had provided 1000 consultations between patients at Gujar Khan and COMSATS Islamabad centre in just a short span of one year (2001-2002). Telemedicine was also proved to be useful in saving valuable civilian lives in the October, 2005 earthquake.⁴ Currently, Aga Khan University has made successful linkage with hospitals in Tajikistan and Afghanistan to promote trans border telemedicine.
In our setup, several factors pose a problem for progress and effective impact of telemedicine. Effective operation of day-to-day telemedicine services will be problematic due to low literacy rate of our population. To combat this, relevant education and training of personnel is imperative. Lack of investors willing to support this initiative is another concern. Studies need to be conducted which demonstrate the cost-effectiveness and benefit of telemedicine in far-flung areas of our country.  Technological malfunction (hardware or software or both) can lead to misdiagnosis and maltreatment. Training of the workforce is the only effective method to ensure such malfunctions to be rectified at earliest.
We feel that in Pakistan, telemedicine has huge untapped potential. Participation of State would facilitate the process of incorporating telemedicine in healthcare structure. The problems mentioned above need to be considered, if we are interested in providing better healthcare to all, no matter the distance.
 
Maria Shoaib, Muhammad Muslim Noorani, Muhammad Farhan Khaliq
4th Year Students, Dow Medical College, Dow University of Health Sciences, Karachi.
Corresponding Author: Maria Shoaib.
Email: syedamariashoaib@gmail.com

1. WHO: Telemedicine - Opportunities and developments in member states. Global observatory of E-Health services 2010; 2.
2. Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. J Telemedicine Telecare 2005; 11: 384-90.
3. Kifle M, Mbarika VWA, Datta P. Telemedicine in sub?Saharan Africa: The case of teleophthalmology and eye care in Ethiopia. J Am Soc Inf Sci Technol 2006; 57: 1383-93.
4. Hussain T. Tele-health: a successful experience in northern areas of Pakistan. Better Healthcare Through Tele-Health. Science Vision 2007; 13: 85.