JMIR Publications

ABSTRACT

Background:

Telemedicine is a strategy for providing healthcare services remotely that improves service accessibility. Telemedicine has attracted growing research interests in the past ten years including systematic reviews that synthesize evidence to share experience and enhance knowledge. However, majority of the published systematic reviews focused on synthesizing evidence of studies on telemedicine at the organizational level. Collected understanding of factors on the system-level that influence the successful implementation and adoption of telemedicine needs to be developed, especially in regional and rural areas.

Objective:

This scoping review aims to explore key success factors and challenges that influence the implementation and adoption of telemedicine at the system level, particularly in regional and rural areas.

Methods:

This scoping review was conducted in accordance with the Arksey and O’ Malley framework and reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A total of five databases (CINAHL, Cochrane, Medline, Ovid, and Scopus) were searched for research articles published in English language between January 2010 and 2023, using established inclusion criteria.

Results:

Of the 10,691 papers identified, 89 were included in this review, which included 16 studies conducted in regional and rural areas. Overall, six categories of more than 70 key success factors (system level requirements; economic considerations and funding; technological requirements; organization requirements; understanding and supporting clinicians; understanding and improving patients’ perceptions) and five categories of more than 50 challenges (system level; technological requirements; organization requirements; clinicians; patient) were identified. Ten of the identified factors were specific to regional and rural areas.

Conclusions:

This scoping review confirms that successful implementation of telemedicine requires collective efforts at both the system and organizational levels including coordination and collaboration across different regions and organizations. It underscores the importance of establishing a national network that enhances public awareness of telemedicine and clarity in payment and benefit distribution models and strengthens data security protection measures. The review also highlights the necessity for addressing infrastructural deficiencies including internet connectivity in regional and rural areas and suggests the implementation of targeted incentives and support measures. The required collected efforts are detailed in the proposed framework that promotes the popularization of telemedicine, enhance the overall quality and efficiency of healthcare services, and achieve broader health equity.