BACKGROUND: Challenged with insufficient number and maldistribution of pathologists, the Philippines seemed poised to benefit from telemedicine.

METHODS: The first modern Internet-based telepathology consultation was conducted between the University of the Philippines Manila and the Armed Forces Institute of Pathology in 1997.

RESULTS: While the first remote telepathology consult was a success, more than a decade after this historic referral, telepathology remains in the fringes of mainstream pathology practice despite its huge potential to benefit the underserved population. Challenges with human, organizational, and technology factors hinder its progress.

CONCLUSIONS: While the original consultation faced difficulties in human capacity, connectivity and infrastructure, rapid developments in governance and technology have the potential to eliminate these problems. Substantial improvements in recent years now provide a more conducive environment to deliver telepathology services to remote areas. This paper proposes a framework for the establishment of mature telepathology services to enable its use in areas of greatest need in the country