Evaluating barriers to adopting telemedicine worldwide: A systematic review
Open accessAbstract
Introduction and objective: Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods: The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results: The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions: Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.
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There is a lack of guidance for use of both synchronous and asynchronous telemedicine, making confidentiality a concern.
“Consistencies with synchronous telemedicine include providing time and cost savings for patients, 51–53 and evidence suggesting a lack of guidance for use of both makes confidentiality a concern. 14,54”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [54]
The Results (page unavailable) identify confidentiality and privacy as telemedicine adoption barriers, including risks from unsecured networks and unencrypted hardware. They do not say that a lack of guidance for synchronous and asynchronous telemedicine causes those concerns. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe COVID-19 pandemic has accelerated the adoption of digital health services.
“The pandemic has accelerated the adoption of digital health services.”
From Acceptance and perceived usefulness of digital health services in the management of chronic urticaria: a survey of patients and physicians (2025) · cites this paper as [37]
The Introduction (Rationale; page unavailable) discusses barriers that slow telemedicine adoption, and the Discussion (Concise summary of main findings; page unavailable) discusses its uses and potential benefits. Neither addresses COVID-19 or a pandemic-driven acceleration in digital health adoption; searches for those terms found no supporting passage in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredLittle is currently known about how to successfully spread and scale up video consulting for sustained use across settings.
“Little is currently known about how to successfully spread and scale up video consulting for sustained use across settings [23-25].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
There was a gap in the reviewed papers on the relevance of interorganizational networking for supporting and sustaining the spread and scale-up of video consulting.
“There was a gap in the papers reviewed, on the relevance of interorganizational networking for supporting and sustaining the spread and scale-up of video consulting [24].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
The same things that interfere with implementation at one site are also seen as interfering with spread and scale-up, although this may be an artifact of how spread is commonly studied as the sum of multiple implementations.
“They also indicate that the same things that interfere with implementation at one site [eg, 48] are also seen as interfering with spread and scale-up [5,7,17,24], although this may be an artifact of how spread is commonly studied as the sum of multiple implementations.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
Findings from the review raised challenges including technically challenged staff, resistance to change, cost, reimbursement, patient characteristics, project management, patient recruitment, leadership involvement, funding, absence of a long-term strategic plan, workflow changes, lack of resources, and liability.
“Findings also raised a number of challenges including the following: technically challenged staff, resistance to change, cost, reimbursement, and patient characteristics [24], as well as project management, patient recruitment, leadership involvement, funding, absence of a long-term strategic plan, resistance to change, workflow changes, lack of resources, and liability [64-66].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
There are gaps in the existing evidence on the spread and scale-up of video consulting, particularly in relation to interorganizational networking, which is critical in enabling and sustaining innovation and yet is not explored in-depth.
“There are gaps in the existing evidence on the spread and scale-up of video consulting. This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
Prior reviews have focused exclusively on the technical aspects of video consulting technology; considered technologies at any stage of implementation rather than technologies with widespread adoption; or restricted the types of articles included to randomized control trials.
“Prior reviews have also focused exclusively on the technical aspects of video consulting technology [7]; considered technologies at any stage of implementation, rather than technologies with widespread adoption [24]; or restricted the types of articles included in the review to randomized control trials [78].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
Interorganizational networking is critical in enabling and sustaining innovation.
“This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
Reviews have focused on telemedicine or eHealth in general without focusing on video consulting, with which our findings are consistent.
“Additionally, reviews have focused on telemedicine or eHealth in general without focusing on video consulting [24,77], with which our findings are consistent.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
Other frameworks do exist that might support spread and scale-up but they have yet to be taken up in the context of expanding video consulting.
“Other frameworks do exist that might support spread and scale-up (see [24] for an overview) but they have yet to be taken up in the context of expanding video consulting.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [24]
A barrier for patients to telemonitoring is unfamiliarity and difficulties in technology access due to generational differences, with older patients experiencing more difficulties interacting with new technologies.
“Broader barriers for patients include unfamiliarity and difficulties in technology access due to generational differences (where older patients experiences more difficulties in interacting with new technologies) and poor digital literacy, [9] and poor internet connectivity. [10]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [9]
A barrier for patients to telemonitoring is poor digital literacy.
“Broader barriers for patients include unfamiliarity and difficulties in technology access due to generational differences (where older patients experiences more difficulties in interacting with new technologies) and poor digital literacy, [9] and poor internet connectivity. [10]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [9]
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- Authors
- Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M.
- Affiliations
- Texas State University, Texas, USA
- Texas State University (US)
- ORCID
- Brooks, Matthew
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2016-10-16
- Volume
- 24
- Issue
- 1
- Pages
- 4-12
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- PMC
- PMC5768250
- OpenAlex
- W2532031923
- Cited by
- 1,735
- References
- 45
- Citations by year
- 2026: 147 · 2025: 221 · 2024: 210 · 2023: 277 · 2022: 323 · 2021: 304 · 2020: 183 · 2019: 49 · 2018: 16 · 2017: 2 · 2016: 2
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Telemedicine and Telecare (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Demography › Technology Use by Older Adults
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- telemedicine, barriers to adoption, technology adoption, resistance to change, employee training, cost, reimbursement, patient age, patient education, change management, health policy
- MeSH terms
- Age Factors, Attitude of Health Personnel, Diffusion of Innovation, Humans, Health Knowledge, Attitudes, Practice, Socioeconomic Factors, Global Health, Telemedicine
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