Telemedicine Pre and Post Covid-19: Lessons for Commercialisation Based on Previous Use Cases

  • George (Gyoergy) Ferenczi La Trobe University, Melbourne,Victoria, Australia
  • Abdun Naser Mahmood La Trobe University, Melbourne, Australia
  • Ralf Konrad Bergmann Semmelweis University, Department of Biophysics and Radiobiology, Budapest, Hungary; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer research, Dresden, Germany
Keywords: COVID-19, telemedicine, health system, respiratory diagnostics, cardiology


Telemedicine used to be slow, difficult, expensive and widely neglected by doctors and patients. COVID-19 changed everything; telemedicine is entering a period of rapid economic and business growth. This paper discusses the reasons for change in telemedicine over the last 20 years, through real-life medical technology projects, telemetry, ehealth and health IT. Our methods are based on the analysis of telemedicine projects we have implemented and characteristic historical data.  The results of our investigation demonstrate a clear increase of significance in telemedicine in the present and near future. We envision the evolution of mobile phones to personal telehealth monitors.  Prior to COVID-19, market penetration and economic factors of telemedicine evolved slowly and in an uneven manner on a global scale. Many of the projects remained active only as long as the grant or corporate or national support was provided. The age of novel globally spreading infectious diseases, exemplified by COVID-19, has created an unusual, different setting. Recent pandemics and epidemics have changed global economics significantly and generated a new motivation and a new market with a projected trillion-dollar market value. Post COVID-19, regular and periodic epidemics and pandemics are expected to continue to occur. This will generate an enormous global market for isolated high-tech services, including telemedicine and telemetry.

Author Biographies

Abdun Naser Mahmood, La Trobe University, Melbourne, Australia

Dr. Abdun Mahmood is an Associate Professor in the Department of Computer Science and IT, La Trobe University. He received his PhD from the University of Melbourne, Australia. He also has a MSc (Research) degree in computer science and

the B.Sc. degree in applied physics and electronics. He has been working as an academic in Computer Science since 1999. Prior

to joining La Trobe University, Dr. Mahmood worked at RMIT University and University of New South Wales. His research interests include application of data mining and machine learning techniques, scalable network traffic analysis, and anomaly detection.

Ralf Konrad Bergmann, Semmelweis University, Department of Biophysics and Radiobiology, Budapest, Hungary; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer research, Dresden, Germany

Dr. Ralf Bergmann is a Professor of Molecular and Preclinical Imaging in the Department of Biophysics and Radiation Biology, Semmelweis University Budapest, Hungary and Guest Scientist at the Helmholtz-Zentrum Dresden-Rossendorf, Germany. He received his PhD from The Martin-Luther University Halle, Germany. He also finished a postdoc qualification as Radiochemist (B.Sc.), Technische Universität Dresden, Germany. He has been working as Biochemist and Radiopharmacologist in R&D of diagnostic and therapeutic Radiopharmaceuticals in the Research Center Dresden since 1981. His research interest includes preclinical imaging and image analysis with PET, SPECT, CT, MRI, US OI and theranostics in cancer.


Bonavia M, Averame G, Canonica W, et al. Feasibility and validation of telespirometry in general practice: The Italian "Alliance" study. Respir Med 2009;103(11):1732-1737. DOI:10.1016/j.rmed.2009.05.006

Maiolo C, Mohamed EI, Fiorani CM, De Lorenzo A. Home telemonitoring for patients with severe respiratory illness: the Italian experience. J Telemed Telecare 2003;9(2):67-71. DOI:10.1258/135763303321327902

Roze R, Fisk M TeleSCoPE. (2013). Telemedicine Coventry University. Available at: accessed 6 December 2020.

Daragó L, Jávor A, How to make eProtocol? In Telemedicine and eHealth ICT Forum for Education, Networking and Business, Luxembourg, 2010, 203-206. ISSN:1818 - 9334,

Reding V, eHealth - Regional case studies. (2006). Available at: accessed 6 December 2020.

European Commisson. (2020). eHealth : Digital health and care. Available at: accessed 6 December 2020.

European Commisson (2020). Shaping Europe’s digital future Available at: accessed 6 December 2020.

Ferenczi G, Vass D, P. I, Csaba E, Darago L, eHealth8 Project: A complex telemedicine system implemented in Hungary, 2008. Available at: accessed 6 December 2020.

WHO Macroeconomics and health : investing in health for economic development : executive summary / report of the Commission on Macroeconomics and Health, World Health Organization, 2001. Available at: accessed 6 December 2020.

Austraian Government. (2018) Australian entities and the EU General Data Protection Regulation (GDPR), Available: accessed 6 December 2020.

European Parialmend. General Data Protection Regulation (2016/697 EC), 2016. Available at: aaccessed 6 December 2020

Bergmo TS. An economic analysis of teleradiology versus a visiting radiologist service. J Telemed Telecare 1996;2(3):136-142. DOI:10.1258/1357633961929952

Bergmo TS. Can economic evaluation in telemedicine be trusted? A systematic review of the literature. Cost Eff Resour Alloc 2009;7(1):18. DOI:10.1186/1478-7547-7-18

Bergmo TS. Economic evaluation in telemedicine - still room for improvement. J Telemed Telecare 2010;16(5):229-231. DOI:10.1258/jtt.2010.009008

Davalos ME, French MT, Burdick AE, Simmons SC. Economic evaluation of telemedicine: review of the literature and research guidelines for benefit-cost analysis. Telemed J E Health 2009;15(10):933-948. DOI:10.1089/tmj.2009.0067

Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform 2010;79(11):736-771. DOI:10.1016/j.ijmedinf.2010.08.006

Himpens B. The Pentalfa project. 4: educational aspects. J Telemed Telecare 2003;9(3):171-175. DOI:10.1258/135763303767149997

Himpens B. The Pentalfa project. 3: participant evaluations of the interactivity of the educational videoconferences and the effectiveness of project promotion. J Telemed Telecare 2003;9(3):167-170. DOI:10.1258/135763303767149988

Himpens B. The Pentalfa project. 2: profile of participants and economic aspects. J Telemed Telecare 2003;9(2):104-108. DOI:10.1258/135763303321327975

Himpens B. The Pentalfa project. 1: the development of distance continuing medical education via videoconferencing in the Dutch-speaking region of Belgium. J Telemed Telecare 2003;9(2):99-103. DOI:10.1258/135763303321327966

Jaana M, Pare G, Sicotte C. Home telemonitoring for respiratory conditions: a systematic review. Am J Manag Care 2009;15(5):313-320. PMID: 19435399.

Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of telehealth: a systematic review. J Telemed Telecare 2003;9(6):311-320. DOI:10.1258/135763303771005207

Miyahara S, Tsuji M, Iizuka C, et al. An economic evaluation of Japanese telemedicine, focusing on teleradiology and telepathology. J Telemed Telecare 2006;12(Suppl 1):29-31). DOI:10.1258/135763306777978579

Mladek T, Stroetmann KA, Bartova S, et al. An economic evaluation of a Web-based national patient records system. J Telemed Telecare 2007;13(5):40-42. DOI: 10.1258/135763307781645185

Moreno-Ramirez D, Ferrandiz L, Ruiz-de-Casas A, et al. Economic evaluation of a store-and-forward teledermatology system for skin cancer patients. J Telemed Telecare 2009;15(1):404-5. DOI:10.1258/jtt.2008.080901

Schaafsma J, Pantazi SV, Moehr JR, Anglin CR, Grimm NA. An economic evaluation of a telehealth network in British Columbia. J Telemed Telecare 2007;13(5):251-256. DOI:10.1258/135763307781458877

Schemken H-W, Au H, Dobrev A, et al. Access to efficient health services for tourists an evaluation of the economic benefits. J Telemed Telecare 2007;13(5):52-55. DOI:10.1258/135763307781645211

Stroetmann KA, Jones T, Dobrev A, Stroetmann VN. An evaluation of the economic impact of ten European e-health applications. J Telemed Telecare 2007;13(5):62-64. DOI:10.1258/135763307781645167

Wainwright C, Wootton R. A review of telemedicine and asthma. Dis Manag Health Out 2003;11(9):557-563. DOI:10.2165/00115677-200311090-00003

United Nations. (2020). COVID-19 to slash global economic output by $8.5 trillion over next two years. Available at: accessed 6 December 2020.

AllegraHMS. (2017). Telemedicine Keeps the Doctor Away Available at: .accessed 6 December 2020.

Szabo B. Development and further improvement of the hungarian national ehealth platform. ed. Human Resources Development Operational Programme: National Healthcare Service Centre (AEEK), 2013. Available at: accessed 6 December 2020.

Bolte R, Walz M, Lehmann KJ, et al. Teleradiology: results of a questionnaire of German radiologists. J Telemed Telecare 1998;4(1):169-171. DOI:10.1258/1357633981931524

Bolte R, Lehmann KJ, Walz M, et al. Radiologic medical desktop conferences--clinical evaluation of the KAMEDIN teleradiology system in routine practice of a radiologic institute. Aktuelle Radiol 1996;6(4):199-202. PMID: 8924455.

Lehmann KJ, Walz M, Bolte R, et al. Possible applications of the KAMEDIN teleradiology system with special reference to an economic analysis. Radiologe 1997;37(4):278-284. DOI:10.1007/s001170050212

Walz M, Bolte R, Lehmann KJ, Lutgemeier J, Georgi M. Economic analysis of teleradiology applications with KAMEDIN. Stud Health Technol Inform 1999;64:208-216. DOI: 10.3233/978-1-60750-908-0-208

McIntosh E, Cairns J. A framework for the economic evaluation of telemedicine. J Telemed Telecare 1997;3(3):132-139. DOI:10.1258/1357633971931039

Collins A. (2017). Funding for telehealth. Available at: accessed 6 December 2020.

Bush A, Saglani S. Management of severe asthma in children. Lancet 2010;376(9743):814-825. DOI:10.1016/S0140-6736(10)61054-9

Ferenczi G. Mobile IP. Report at: Nokia Wireless Business Communication and the Tampere University of Technology Tampere, 1999.

Latifi R, Weinstein RS, Porter JM, et al. Telemedicine and telepresence for trauma and emergency care management. Scand J Surgery 2007;96(4):281-289. DOI: 10.1177/145749690709600404

Weinstein RS, Lopez AM, Krupinski EA, et al. Integrating telemedicine and telehealth: putting it all together. Stud Health Technol Inform 2008;131: 23-38. PMID: 18305320

Ferenczi G. Advanced Security Database access with Security Solutions Simulation in Java, M.Sc., University Tampere, Tampere, 1998,.

Melvin E, Cushing A, Tam A, Kitada R, Manice M. Assessing the use of BreatheSmart(R) mobile technology in adult patients with asthma: a remote observational study. BMJ Open Respir Res 2017;4(1):e000204. DOI:10.1136/bmjresp-2017-000204

Liu WT, Huang CD, Wang CH, et al. A mobile telephone-based interactive self-care system improves asthma control. Eur Respir J 2011;37(2):310-317. DOI:10.1183/09031936.00000810

McLean S, Chandler D, Nurmatov U, et al. Telehealthcare for asthma. Cochrane Database Syst Rev 2010;(10):CD007717. DOI:10.1002/14651858.CD007717.pub2

Ferenczi G. Method of transmitting results of diagnostical measurements in MMs via GSM network, Patent Appl. P1100371/8, A61B 5/00, H04W 4/12, 2011.

Ferenczi G. Method of compressing and restoring pulmonological FVC graphs Patent Appl. P1100370/9, A61B 5/08, H03M 7/30, 2011.

Glatte GC. (2018). Fundamentals and Aspects of Telemedicine ECG Transmission (TET) in combination with Telematic Heart Disease Support (THDS) including General Considerations concerning structure of Telemedicicine frameworks and adding other relevant parameters as lung function testing provided by PC based spirometers. Available at: accessed 6 December 2020.

Chan DS, Callahan CW, Hatch-Pigott VB, et al. Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial. Pediatrics 2007;119(3):569-78. DOI:10.1542/peds.2006-1884

Moga VD, Moga M, Avram R, Ciocarlie T, Bosneag L. Telecardiology in Clinical Practice: A One Decade Experience. in Med-e-Tel 2010, Luxembourg, 2010: International Society for Telemedicine & eHealth (ISfTeH), ISSN 1818 - 9334

Ferenczi G. Method for diagnostic measurement of respiratory function and apparatus for carrying out said method. Patent Appl. P0500517, 2005.

Ferenczi G, Method and apparatus for determining the flow parameters of a streaming medium, Patent Appl. WO/2009/071960, PCT/HU2008/000146, 2009.

Bergman DA, Sharek PJ, Ekegren K, et al. The use of telemedicine access to schools to facilitate expert assessment of children with asthma, Int J Telemed Appl 2008;159276. DOI:10.1155/2008/159276

von Berg A, Filipiak-Pittroff B, Schulz H, et al. Allergic manifestation 15 years after early intervention with hydrolyzed formulas--the GINI Study. Allergy 2016;71(2):210-9. DOI:10.1111/all.12790

Doupi P, Renko E, Hämäläinen P, et al. eHealth Denmark : eHealth Strategies, Denmark, in "DG Information Society and Media, ICT for Health Unit" European Commission, 2010. Available at: accessed 6 Dec 2020.

Darkins A, Ryan P, Kobb R, et al. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health 2008;14(10):1118-1126. DOI:10.1089/tmj.2008.0021

AAL Association. (2020). Active Assisted Living Programme (AAL). Available at: accessed 6 December 2020.

Sufi F, Khalil I, Mahmood A. A clustering based system for instant detection of cardiac abnormalities from compressed ECG. Expert Syst Appl 2011;38(5):4705-47113. DOI:

Orlik T, Rush J, Cousin M, Hong J. (2020). Coronavirus Could Cost the Global Economy $2.7 Trillion. Here’s How. Available at: accessed 6 December 2020.

Project ARA. (2020). Available at: accessed 6 December 2020.

Pensworth L. (2020).What Happened to Project Ara? Available at: accessed 6 December 2020.

Orosz G. Design and development of a compact lung function monitoring device, M.Sc., Technical University of Budapest, Budapest, 2009.

Garrett TA. Economic Effects of the 1918 Influenza Pandemic. Implications for a Modern-day Pandemic, Federal Reserve Bank of St. Louis, St. Louis, 2007. Available at: accessed 6 December 2020.

CDC. (2018). The 1918 Flu Pandemic: Why It Matters 100 Years Later. in Public Health Matters Blog. Available at: accessed 6 December 2020.

How to Cite
Ferenczi, G. (Gyoergy), Mahmood, A., & Bergmann, R. (2020). Telemedicine Pre and Post Covid-19: Lessons for Commercialisation Based on Previous Use Cases. Journal of the International Society for Telemedicine and EHealth, 8, e8 (1-10).