A groupware that integrates synchronous and asynchronous collaboration paradigms is developed to support international medical collaboration activities carried out among Japan, Sri Lanka and other countries in Asia. Synchronous medical collaboration activities are facilitated through high-quality image transmission and through an interactive shared-workspace. A web based asynchronous collaboration environment facilitates file uploading, editing and reviewing functions. Provisions such as multi-stream session recording, enhanced object linkage of collaboration contents, and persistent data sharing, harness the integrated collaborative environment. Adaptive M-JPEG transmission, application level multicasting and mirrored database architecture enables efficient data transmission among heterogeneous groups connected through wide range of network channels.