The ITeHP-CV has been successfully launched, and the initial results are encouraging. The continuity of the program and sustainability are primary goals once the program is transferred fully to the Ministry of Health of Cabo Verde. A long-term follow-up study is required in order to ensure sustainability and continuity goals are met.

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

IBOT has been successful, but further studies are needed to demonstrate its effectiveness in countries beyond the Balkans.

The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leaving behind Albanian physicians systematically excluded from advanced medical services for a decade and medical facilities severely damaged in the course of departure in a region with an infrastructure fragmented over the years. The medical system of Kosova can be analyzed for the effectiveness of the many efforts following the disruption of medical care in the 1990s. In this paper, the application of telemedicine and information is recounted. The medical system of Kosova was offered the concept of the International Virtual E-Hospital and this model was used to support, supplement, and guide a massive program development that involved essentially every physician and medical personnel in the region. Currently, the Telemedicine Center of Kosova (TCK) is providing information resources for medical education programs within the Kosova's medical system as well as regional and international consultations and collaboration. Furthermore, it is developing the human resources that will lead and implement telemedicine programs in this region and making serious strides in the redevelopment of medical systems using information technology.

TMP is an efficient mechanism to ensure CME and rebuilding medical systems in developing countries. There is a need for prospective CBA of any TMP and the establishment of M&E programs in any future telemedicine initiatives in developing countries.