Evaluating barriers to adopting telemedicine worldwide: A systematic review

Abstract

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.

Keywords: Barriers; adoption; implementation; mHealth; telemedicine.

Figure 1.

Literature search with inclusion and exclusion criteria.

Figure 2.

Frequency of barriers by country. This figure graphically organizes the barriers listed for each country in order of frequency from the literature. The authors categorized these by country or continent. The numbers in each bar correspond to the reference number of the article which also aligns with the order in the References section. A preponderance of the literature stems from the USA (40%), followed by Europe (33%), Australia (10%), Africa (9%), the Middle East (6%), and India (3%).

Figure 3.

Frequency of barriers for organizations. This figure graphically organizes the barriers listed in order of frequency. The authors categorized these as organizational barriers to the adoption of telemedicine. The numbers in each bar correspond to the reference number of the article which also aligns with the order in the References section

Figure 4.

Frequency of barriers for patients. This figure graphically organizes the barriers listed in order of frequency. The authors categorized these as patient barriers to the adoption of telemedicine. The numbers in each bar correspond to the reference number of the article which also aligns with the order in the References section.

Figure 5.

Frequency of barriers for staff and programmers. This figure graphically organizes the barriers listed in order of frequency. The authors categorized these as staff and programmer barriers to the adoption of telemedicine. The programmer barriers are the last three on the right. The numbers in each bar correspond to the reference number of the article which also aligns with the order in the References section.