In this sense, little knowledge currently exists among medical practitioners on how to effectively and practically use various forms of telemedicine. This knowledge gap on insight into telemedicine, in effect, hinders the creativity to explore more efficient and effective modalities of telemedicine applications. As a result, teaching medical practitioners to learn and adopt this new way of accomplishing health services, through telemedicine, has become a significant hurdle to implementation Turner, 2003. Special competence is also required before implementation of telemedicine can be allowed and render success to those concerned. In this regard, a unique term, telecompetence, was created to describe the required skills and credentials practitioners must have in order to carry out this kind of specialized work Turner, 2003.

Telecompetence is a must in order to be a health communication expert regarding telemedicine. In particular, according to Turner (2003)

, there is a three-stage process involved in such health communication aptitude. As such, telecompetence consists of;

1. planning and establishing,

2. learning and use, and

3. Formalizing routines.

Unfortunately, achieving this level of competence could be considered a major adversary to telemedicine implementation, because considerable training and finances are not always available resources to enable this kind of campaign. To this end, in some medical settings where resources are limited, telemedicine may not be a feasible or affordable option.

According to Edwards et al., 2005()

telemedicine has its limitation compared traditional, face-to-face diagnosis. Face-to-face diagnosis offers an added advantage where interactions can be combined with physical comparisons. In the case where physical contact is said to provide a perfect avenue for diagnosis telemedicine can then be termed as inadequate. The inadequacy is worsened by the physician's competencies and experience. Experienced physician can be able to make complete and accurate diagnosis using limited information which makes telemedicine appropriate. In reality however, the experience of physician is limited in term of regions of operation and the number of years in practice Mort et al., 2003.

This brings out the ineffectiveness of wholesomely relaying on telemedicine.

The quality of technology used by Physicians and patients greatly contributes to the diagnosis and thus effectiveness of telemedicine. In the world technology is not standardized thus, in as much as telemedicine is breaking geographical boundaries, its overall application in global perspective is limited Bar-Yam, 2006()

Accountability of medical practitioners in the telemedicine is limited owing to its admissibility in certain region and lack of broad guidelines. The argument brought out by Brookfield and Smith (2006)

, is that individual physician will set their guiding principle according to the best interpretation laws concerning malpractice. Observed from this issue is that a set of guidelines touching on practicing telemedicine is required in order to avoid inadequate diagnosis and treatments.

Solution

Training to Medical Practitioners

The continued growth of telemedicine needs to be harnessed and incorporated in the management of hospital information systems. For result in the provision of healthcare using telemedicine, there is the need to consider training to physicians and attending nurses. This will increase efficiency as telemedicine is offered by allowing for coordination of actions and expectation as well and diagnosis. Physicians need to be trained through refreshers courses to equip them with diagnosis information and reading digital data.

Training to medical practitioners may enlist feelings of inadequacy among the staff and also reduce motivation among those who are not offered the training. To the hospital, it will seem be a venture whose needs are not conceptualized.

Licensing and practicing

Licensing and practicing telemedicine should be considered as a new development, and new measures to govern it are required. The authorities need to come up with regulatory measures that are linked to Telemedicine as opposed to the existing guides. The need to incorporate countries and regions in the creation the rules and licensing procedure is emphasized owing to the fact that telemedicine has no boundaries.

Coming up with rules, regulation and licensing boards for telemedicine will entail a bureaucratic process which may lead to stagnated growth of the developments made. The ideal measure would be to have states incorporate their own measures, rules and regulation governing the practice of telemedicine and then tries later standardize theme to fit the standards of the world. This process may take a while but, it is much better.

Payments and Reimbursements

In some instances need arise for a physician to offer healthcare to patient with consideration for their payments. The Telemedicine development have not been able to incorporate direct payment to Physicians rather they get reimbursements it is evidenced that the growth in practice may not be sustainable if a payment system is not considered. There is the need to consider online payment methods which greatly contributes to the field's growth.

Recommendations

In the present day and age, we know that a considerable portion of world society relies mostly on technology and electronics for communications,...

With the advent and advancement of telemedicine -- especially via the Internet -- our medical and health care systems have taken a near complete redirection in how health communication is channeled and exchanged. Humans on all sides of the health care system are now becoming digitized, virtual, and cyber Turner, 2003.
Brookfield and Smith (2006)

, adds that activities by humans to embrace technology has increased in a substantial telemedicine and its modernization.

It is interesting that the subtractive communicative effects of telemedicine have often been overlooked in health communication. In addition, Turner (2003)

argued that few studies have been conducted on the communicative and interpersonal implications of telemedicine. Thus, we believe that it is important to address this issue.

Indeed, e-health services represent the most interpersonally and communicatively reductive telemedicine technologies that exist today Brookfield & Smith, 2006.

The reason lies in the fact that face-to- face contact and nonverbal communication are absent or absolutely minimal in this medium Roback & Herzog, 2003.

As such, telemedicine services on the Internet (i.e., e-mail) deprive humans of the fundamental contact that is so essential in social interactions Roback & Herzog, 2003.

Although Bar-Yam, 2006()

has argued that e-mail can provide a rich social presence, others assert that e-mail services are mere exchanges of written words, absent of any facial expressions and gestures Aragon (2003)

and that they diminish interpersonal contact with others because all communication is electronic Aragon, 2003.

Also, because telemedicine can be a sort of dialogue between distant users, e-mail is oftentimes adopted as a channel to carry out such dialogue. Unfortunately, e-mail is appropriate only for asynchronous communication. In addition, the present condition of the Internet does not usually produce expeditious delivery times Turner, 2003.

So the question arises as to why e-mail is preferred if it is oftentimes slower than other forms of communication.

Likewise, health care information that is posted on WebMD.com does not require that the information-seekers consult with a human being or physically visit with someone in an office. For instance, health care consumers can search for pharmaceutical information (i.e., prices, descriptions, side effects, and contraindications) and diagnostic information about diseases (i.e., images, symptoms, and current and innovative treatments) on these types of sites without any personalized visits, phone calls, or any manner of communication that requires two individuals to exchange ideas. It seems that the Internet provides a user-friendly, omniscient encyclopedia of health care information, allowing doctors to be thrown on the wayside or deemed obsolete in many cases. To this end, Internet-based telemedicine services can, in many cases, erase or at least significantly reduce the need for human communication and contact.

Reference

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