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dc.contributor.authorKruse, Clemens S. ( Orcid Icon 0000-0002-7636-1086 )
dc.contributor.authorKarem, Priyanka ( Orcid Icon 0000-0003-1720-6980 )
dc.contributor.authorShifflett, Kelli ( )
dc.contributor.authorVegi, Lokesh ( )
dc.contributor.authorRavi, Karuna ( Orcid Icon 0000-0002-5460-127X )
dc.contributor.authorBrooks, Matthew ( )
dc.identifier.citationKruse, C. S., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare, 24(1), pp. 4–12.en_US

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.

dc.format.extent9 pages
dc.format.medium1 file (.pdf)
dc.publisherSage Publishingen_US
dc.sourceJournal of Telemedicine and Telecare, 2018, Vol. 24, No. 1, pp. 4–12
dc.titleEvaluating Barriers to Adopting Telemedicine Worldwide: A Systematic Reviewen_US
dc.rights.licenseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (



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