Beyond "Initiate-Build-Operate-Transfer" strategy for creating sustainable telemedicine programs: lesson from the first decade.

December 10, 2012 will mark the 10th anniversary of the implementation of telemedicine in the Balkans. This first decade of development and function is due to the passion, creativity, experience, and implementation know-how of the award-winning concept of the International Virtual e-Hospital (IVeH) Foundation. The objective of this article is to analyze the results of the IVeH's core strategy, "Initiate-Build-Operate-Transfer" (IBOT), which has been instrumental in establishing telemedicine in the Balkans and has been adopted by many other countries worldwide, and to describe the lessons learned that go beyond IBOT. A retrospective review of the results of IVeH engagement in establishing telemedicine in developing countries was conducted. Using IBOT, the IVeH has successfully established two national programs: one in Kosova and one in Albania. Together, they have connected 16 hospitals. Currently IVeH is in the process of creating such programs in many countries around the world. During the analysis of the first decade, we have identified eight factors that should be considered when establishing telemedicine programs. IBOT has been successful, but further studies are needed to demonstrate its effectiveness in countries beyond the Balkans.