424 Copyright © 2012, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Chapter 16 INTRODUCTION A primary goal for public health systems is to provide equal quality health services to the entire population. Most developing countries consider this to be a fundamental challenge. One of the largest constraints in developing countries’ public health sectors is the acute shortage of financial resources that inevitably leads to a shortage of medical expertise. Referral systems aim to utilise scarce resources more effectively by ranking Maria J. Treurnicht Stellenbosch University, South Africa Liezl van Dyk Stellenbosch University, South Africa Clinical-Pull Approach to Telemedicine Implementation Policies using Health Informatics in the Developing World ABSTRACT Telemedicine could effectively aid hospital referral systems in bringing specialized care to rural com- munities. South Africa has identifed telemedicine as part of its primary health care strategic plan, but similar to many other developing countries, the successful implementation of telemedicine programs is a daunting challenge. One of the contributing factors is the insuffcient evidence that telemedicine is a cost-effective alternative. Furthermore, many telemedicine services are implemented without a thorough needs assessment. Throughout this chapter, the authors investigate the use of medical informatics in quantitative telemedicine needs assessments. A framework is introduced to direct implementation policies towards a proven clinical need rather than pushing technology into practise. This clinical-pull strategy aims to reduce the amount of failed projects, by providing decision support to implement appropriate technologies that have the potential to contribute towards better quality healthcare. DOI: 10.4018/978-1-4666-0888-7.ch016