In telemedicine, medical images are always considered very important telemedicine diagnostic evidences. High transmission delay in a bandwidth limited network becomes an intractable problem because of its large size. It’s important to achieve a quality balance between Region of Interest (ROI) and Background Region (BR) when ROI-based image encoding is being used. In this paper, a research made on balancing method of LS-SVM based ROI/BR PSNR prediction model to optimize the ROI encoding shows it’s much better than conventional methods but with very high computational complexity. We propose a new method using extreme learning machine (ELM) with lower computational complexity to improve encoding efficiency compared to LS-SVM based model. Besides, it also achieves the same effect of balancing ROI and BR.