I appreciated the balanced perspective in “Evolving Regulations in Telemedicine Pilot Project: Insights Into Law, Practice, and Patient Care through International Case Studies,” 1 which effectively contrasts legislative and practical nuances across countries. I wish to offer an additional insight from the Czech Republic (Czechia). Despite cultural and structural differences, a parallel with South Korea (Korea) can be observed. The COVID-19 pandemic disrupted a previously narrow scope of telemedicine and demonstrated its value. In a telemedicine market with high consumer demand and limited provider supply,2 be it Korea or Czechia, conditions exist under which a “platform war”, i.e., commercial logic-driven rivalry among convenience-focused platforms, may emerge. In the Czech context, a comparable “regional battle”, i.e., competition among regional governments introducing fragmented initiatives, is ready to unfold.

Before the pandemic, telemedicine adoption in Czechia was minimal and largely confined to pilot projects. Early national eHealth initiatives, such as the IZIP electronic health record (EHR) launched in 2008, failed due to low uptake and integration issues, leaving a legacy of public scepticism toward large state-led digital health projects. Mandatory ePrescribing was planned from 2015, but met strong opposition from physicians and was delayed. Yet during the COVID-19 period, ePrescription became central to care delivery, often issued after phone or messaging-app consultations, underscoring the absence of a national telemedicine infrastructure.

In 2024, telemedicine was formally regulated through a law and public notice, setting baseline quality and security standards and replacing previous vague provisions. However, recent developments show that innovation is being driven by regional rather than national actors. This pattern resembles developments in other European countries and contrasts with those following centralised telemedicine implementation strategies.3 For example, in Sweden, regional authorities launched telemedicine pilots independent of the central government yet integrated at the national level.4 In contrast, Italian “extensive regional autonomy” led to considerable EHR fragmentation.5 Concerningly, Czechia seems to follow the Italian route rather than the Swedish one.

Two regional examples illustrate this trend. In 2023, the Moravian-Silesian Region established TeleMedPoints, which are similar to telemedicine cabins6 but staffed by mobile nurses or health assistants and located in non-healthcare facilities such as municipal offices. Connected to the regional telemedicine centre, these points target older adults in remote mountain areas, relying on personnel rather than patients’ digital literacy.7 In 2024, the South Bohemian Region, followed by the Karlovy Vary Region early in 2025, introduced a 24/7 “online emergency” service accessible via a commercial mobile app, including a chat feature.8 While conceptually similar to Sweden’s integrated 1177 platform, it lacks national integration, does not require trusted patient identification credentials, issued either by the state or by banks (BankID),9 and is free only for local residents, with fees for others. Such differences risk creating new forms of digital health disparities if other regions do not follow suit.

Understandably, telemedicine implementation strategies tend to be strongly influenced by national contingencies, such as the degree of regional autonomy in health-related matters (Table 1). When regional authority is high or medium, the bottom-up, region-driven pattern has clear strengths: it enables rapid, targeted innovation without waiting for central government action. However, without mechanisms for coordination, evaluation, and sharing of best practices, decentralisation risks producing a fragmented digital health landscape.

While underpinned by commercial rather than regional logic, Korea’s experience offers a relevant warning. As noted in the JKMS article, Korea’s telemedicine expansion has led to a “platform war,” with competing systems often driven by commercial interests rather than coordinated public health planning. While Czechia is not yet facing strong commercial platform competition, the risk of an inter-regional telemedicine battle is real. Without effective national-level governance,10 regions may adopt incompatible technologies and divergent access models, resulting in unequal service availability, poor interoperability, and inefficient use of public funds.

The lesson from Korea is that governance frameworks must evolve alongside innovation. In European countries with medium to high levels of regional authority, national policy should not suppress regional telemedicine initiatives but should set interoperability standards, ensure equitable access, and provide stable funding and oversight. Put differently, national policy must “balance local autonomy with national cohesion.”11 Incentives for cross-region service integration are therefore desirable. These steps would allow countries like Czechia to build on GP-led primary care strengths while avoiding the pitfalls of fragmented, platform-driven growth. By learning from Korea’s and Italy’s challenges, as well as Sweden’s controlled experimentation, telemedicine can be positioned as a coherent, integrated service, preventing a regional battle before it begins.