Barriers and Facilitators to Pediatric Emergency Telemedicine in the United States
Open accessAbstract
BACKGROUND: Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use. MATERIALS AND METHODS: We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States. RESULTS: We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1-30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites. CONCLUSIONS: Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.
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The questionnaire was derived from the literature on telemedicine satisfaction and experts in telemedicine.
“The questionnaire was derived from the literature on telemedicine satisfaction and experts in telemedicine [23-28].”
From Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study (2021) · cites this paper as [24]
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Erdogan, S. A., Phan, K., Toplu, S. G., Krupski, T. L., & Lobo, J. M. (2024) · Computers & Industrial Engineering · doi:10.1016/j.cie.2024.110242 · Cited by 3 · see citing works
Professional Isolation: Impact on Rural Nurses Resuscitation Practices and Experiences
Riley, K., Wilson, V., Middleton, R., & Molloy, L. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16649 · Cited by 3 · see citing works
Rowther, A. A., Mehmood, A., Razzak, J., Atiq, H., Castillo‐Salgado, C., & Saleem, H. T. (2022) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2022.100150 · Cited by 3 · see citing works
Telehealth as a Tool to Transform Pediatric Care: Views from Stakeholders
Jones, E. B., & Cross‐Barnet, C. (2023) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2022.0496 · Cited by 3 · see citing works
Hu, Y., Wang, J., Gu, Y., Nicholas, S., Maitland, E., & Zhou, J. (2024) · Digital Health · doi:10.1177/20552076241272525 · Cited by 2 · see citing works
“Compared to the previous studies, 50,52 our detailed fi ndings on waiting time and consultation duration provide practical suggestions to OMC providers.”
BackgroundResultNarratives of Clinicians on Telemedicine and Delivery of Quality Healthcare in Ghana
Yarney, L., Mintah, N. A., Ayisi, E. K., & Adzei, F. A. (2023) · Open Journal of Social Sciences · doi:10.4236/jss.2023.118017 · Cited by 2 · see citing works
A SIX-DIMENSIONAL FRAMEWORK FOR TELEHEALTH DELIVERY
(2020) · Issues in Information Systems · doi:10.48009/2_iis_2020_102-111 · Cited by 1 · see citing works
“One such issue is the tension between state laws on medical licensure telemedicine (Uscher-Pines & Kahn, 2014).”
BackgroundRosenthal, J. L., Ketchersid, A., Horath, E. T., Sanders, A., Harper, T. A., Hoyt-Austin, A. E., & Haynes, S. C. (2023) · Digital Health · doi:10.1177/20552076231219123 · Cited by 1 · see citing works
“27,28,11,26 Providers described that their lack of con fi dence in using the telehealth equipment left them feeling vulnerable and “ silly, ” thus reducing their willingness to use telehealth.”
BackgroundRosenthal, J. L., Mouzoon, J. L., & Marcin, J. P. (2020) · Springer eBooks · doi:10.1007/978-3-030-56917-4_21 · Cited by 1 · see citing works
Trial By Fire: Impact of Rapid Expansion of Telemedicine in a Large Community Health System
Stratton-Smith, S., Nardi, C., & Snyder, B. (2021) · Advances in Clinical Medical Research and Healthcare Delivery · doi:10.53785/2769-2779.1002 · Cited by 1 · see citing works
Emergency Departments’ Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study
Zachrison, K. S., Hayden, E. M., Boggs, K. M., Boyle, T. P., Gao, J., Samuels‐Kalow, M. E., Marcin, J. P., & Camargo, C. A. (2022) · Journal of Medical Internet Research · doi:10.2196/33981 · Cited by 1 · see citing works
“A previous mixed methods study of 17 programs providing pediatric telehealth services reported a number of barriers and facilitators to adoption and successful maintenance of telehealth programs [15].”
BackgroundInfluentialThe Determinants of the Use of Telemedicine in Senegal
Ly, B. A. (2016) · uO Research (University of Ottawa) · doi:10.20381/ruor-855
“Physicians may equally think that telemedicine is time-consuming and increases work overload (Taylor & Coates, 2015; Uscher-Pines & Kahn, 2014).”
BackgroundThe Integration of Telemedicine into Clinicians’ Workflow: A Scoping Review
Olivencia, S. B., & Sasangohar, F. (2020) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/1071181320641140
“…review (Armstrong et al., 2012; Cady et al., 2010; Cady & Finkelstein, 2012, 2013, 2014; Cronin et al., 2012; Facchin et al., 2016; Fish et al., 2011; Kaufman et al., 2009; Koopman et al., 2014; Ricci et al., 2014; Shaw et al., 2013; Tang et al., 2007; Uscher-Pines & Kahn, 2014; Yen et al., 2016).”
Developing a Framework for Telehealth Integration into Clinical Workflow
Olivencia, S. B., & Sasangohar, F. (2020) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/1071181320641139
“However, concerns regarding the negative impacts of the integration of telehealth technologies into established workflow have posed a significant barrier for the adoption of telehealth technologies in clinical settings (Koopman et al., 2014; Menachemi et al., 2004; Uscher-Pines & Kahn, 2014).”
BackgroundScelfo, B., Grosso, M., Dalmasso, M., Bellelli, S., Rivoiro, C., Romano, V., Alesina, M., Ballesio, M., Presutti, M., Ceruti, M., et al. (2022) · Revue francophone sur la santé et les territoires · doi:10.4000/rfst.1359
(2021) · Elsevier eBooks · doi:10.1016/b978-0-12-824161-5.16001-3
Olivencia, S. B., Sultana, I., Larsen, E. P., Zheng, F., & Sasangohar, F. (2022) · doi:10.2196/preprints.39514
TELEMEDICINE PAYMENT SYSTEM BASED ON QUALITY: A SCOPING REVIEW
Fatma, Z. H., & Nugraha, R. R. (2022) · Jurnal Ekonomi Kesehatan Indonesia · doi:10.7454/eki.v7i2.5559
Revolutionizing Pediatric Emergency Care: the Impact of Telemedicine: A Narrative Review
Abo‐elnour, D. E., Ahmed, B. A., Ghonaim, M. M., Iqbal, A., Okesanya, O. J., Ghouri, A., Gamboa, L. L., & Alsabri, M. (2025) · Current Emergency and Hospital Medicine Reports · doi:10.1007/s40138-025-00325-x
Karamagioli, E., Pikouli, A., Antonopoulou, I., & Chatzi, E. (2026) · Hot topics in acute care surgery and trauma · doi:10.1007/978-3-032-09357-8_10
Soflaee, M., Pourghasem, M., Hosseini-Vajari, A., Bahrami, R., Golshan-Tafti, M., Aarafi, H., Shajari, A., Noroozi, N., & Neámatzadeh, H. (2026) · Sage Open Pediatrics · doi:10.1177/30502225261490412
- Authors
- Uscher-Pines, L., & Kahn, J. M.
- Affiliations
- RAND Corporation
- University of Pittsburgh (US)
- ORCID
- Kahn, Jeremy M.
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2014-11
- Volume
- 20
- Issue
- 11
- Pages
- 990-996
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC4229699
- OpenAlex
- W1986899721
- Cited by
- 81
- References
- 20
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 12 · 2020: 10 · 2019: 7 · 2018: 6 · 2017: 9 · 2016: 6 · 2015: 3
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pittsburgh
- Health Resources and Services Administration
- U.S. Public Health Service (H3AMC24076)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- telehealth adoption barriers, success factors, workflow integration, technology usability, physician buy-in, reimbursement, clinical champions, rural emergency departments, underserved areas
- MeSH terms
- Diffusion of Innovation, Emergency Medicine, Humans, Pediatrics, Practice Patterns, Physicians', Surveys and Questionnaires, United States, Telemedicine, Quality Improvement
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