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Cited by 173Telemedicine and Telehealth ImplementationGlobal Health and SurgeryGlobal Health Workforce Issues

Telemedicine across borders: A systematic review of factors that hinder or support implementation

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Saliba, Vanessa, Legido-Quigley, Helena, Hallik, Riina, Aaviksoo, Ain, Car, Josip, McKee, Martin·2012·International Journal of Medical Informatics
DOI 10.1016/j.ijmedinf.2012.08.003
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Abstract

Purpose Innovative technologies to deliver health care across borders have attracted both evangelists and sceptics. Our aim was to systematically identify factors that hinder or support implementation of cross-border telemedicine services worldwide in the last two decades.Methods Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011 including citations from 1990 onwards when at least an abstract was available in English. We also searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or (b) described the factors that hinder or support implementation of cross-border telemedicine services. All study designs were included. Two reviewers independently assessed titles and abstracts of articles identified. Papers were allocated to one of four reviewers who extracted relevant data and validated it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence.Results 6026 records were identified of which 5806 were excluded following screening of titles and abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide, most involving collaborations between high and low or middle income countries. Most described services delivering a combination of types of telemedicine but specialties most represented were telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health professionals, with only a few linking professionals directly to patients. A main driver for the development of cross-border telemedicine is the need to improve access to specialist services in low and middle income countries and in underserved rural areas in high income countries. Factors that hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability factors; (3) cultural factors; and (4) contextual factors.Conclusions National telemedicine programmes may build infrastructure and change mindsets, laying the foundations for successful engagement in cross-border services. Regional networks can also help with sharing of expertise and innovative ways of overcoming barriers to the implementation of services. Strong team leadership, training, flexible and locally responsive services delivered at low cost, using simple technologies, and within a clear legal and regulatory framework, are all important factors for the successful implementation of cross-border telemedicine services.

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  • Infrastructure features important for implementation include electricity supply, available bandwidth, reliable internet connectivity, access to computers, electrical power, and access to phone lines and mobile phones.

    “Infrastructure features included electricity supply [51], available bandwidth [31, 51], access to reliable internet connectivity [45, 51], access to computers [34], electrical power [45] and access to phone lines and mobile phones [45].”

    From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [51]

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Authors
Saliba, V., Legido-Quigley, H., Hallik, R., Aaviksoo, A., Car, J., & McKee, M.
Affiliations
London School of Hygiene & Tropical Medicine (GB)
ORCID
Venue
International Journal of Medical Informatics
Publisher
Elsevier BV
Published
2012-12
Volume
81
Issue
12
Pages
793-809
ISSN
1386-5056 (ISSN-L)
DOI
10.1016/j.ijmedinf.2012.08.003
OpenAlex
W2148091684
Cited by
173
References
80
Citations by year
2026: 6 · 2025: 11 · 2024: 14 · 2023: 9 · 2022: 8 · 2021: 12 · 2020: 23 · 2019: 18 · 2018: 11 · 2017: 12 · 2016: 11 · 2015: 16 · 2014: 12 · 2013: 10
FWCI
1.90
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Medical Informatics (publishedVersion)
  • PubMed (publishedVersion)
  • Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
Funders
Imperial College London
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
Keywords
telehealth implementation, implementation barriers, telepathology, telesurgery, teleradiology, access to specialist care, low- and middle-income countries, rural health care, legal and regulatory framework, sustainability, cultural factors, regional health networks, international health cooperation
MeSH terms
Culture, Humans, International Cooperation, Leadership, Neoplasms, Telemedicine

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