As far as the patient is concerned, if a clinical process can be carried out remotely it matters little whether the clinician is in the next room, a nearby building or, for that matter, another country. It is therefore no surprise that outsourcing is becoming an issue just as a significant number of wireless ehealth applications move beyond trial phase.

Telemedicine was originally seen as a way of delivering sophisticated clinical processes available in developed countries to patients in underdeveloped countries. Today changes in the demographic profiles of both developing and developed countries mean that the flow of services has been reversed.

Clinicians, and some healthcare trust managers, fear outsourcing will lead to a loss of skills within the UK. However cost savings could free up resources and allow the NHS to concentrate on core competencies such as surgery. At present surgery is being outsourced from overseas as patients arrange their own operations in other European countries.

So as not to alarm clinicians outsourcing companies tend to play down the impact of the low cost of the services they provide. However, claims by outsourcing providers that they are merely exploiting their geographic location to provide services out of UK working hours are unlikely to placate the fears of health workers who are well aware of the impact outsourcing is having on the IT sector. At the same time understating potential savings will discourage potential early adopters of outsourced services within the private healthcare sector.

It could be argued that outsourcing provides some relief from the pillaging of hospitals and medical centres in developing countries by agencies recruiting staff to work in the NHS. However health workers who leave developing countries usually do so on fixed term contacts and return when those contracts end. While working overseas many health workers send money home to their families. On the other hand health workers employed in outsourcing centres are beyond the reach of patients in developing countries – just as they would be if they worked overseas. Overall, in the short to medium term, outsourcing will have a neutral impact on a developing country.

To make outsourcing and offshoring of healthcare services a viable proposition issues regarding access to electronic patient records by clinicians outside of the UK and EU will have to be resolved.