Barriers to Telemedicine Establishment in Iran: A Systematic Review
-
Mohammad Hossein Mehrolhassani
,
Vahid Yazdi-Feyzabadi
,
Reza Dehnavieh
,
Kambiz Bahaadinbeigy
,
Mohammad Kargar
Abstract
Background: Despite the implementation of some experimental and temporary telemedicine projects in Iran in recent years, it has not been deployed in formal healthcare services. The first step in establishment of this technology in health system is identification of barriers of this area. Therefore, this study aimed to identify the barriers to telemedicine establishment in Iran health system.
Methods: A systematic review was conducted according to PRISMA guidelines. Searches were conducted in PubMed, Web of Sciences, Scopus, Cochrane Library, Iranmedex, Magiran, SID and Google Scholar. The inclusion criteria were studies that reported barriers to telemedicine in Iran, non-review studies, published studies in English and Persian between Nov 22, 2010 and Mar 20, 2022. Data were analyzed using narrative synthesis and deductive-inductive thematic analysis and the World Health Organization building blocks framework was used in this regard.
Results: Out of 1148 studies identified, 21 studies met the inclusion criteria for review. The findings fell into four themes, including governance/leadership, financing, health workers, and health information system besides 11 sub-themes. No specific findings were derived from the building blocks of service delivery and medical product, vaccines and technologies.
Conclusion: Governance is an integral part of other building blocks of the health systems. Hence, overcoming the barriers in this field can be prioritized. Therefore, ensuring the existence of strategic policy frameworks along with some other factors such as effective supervision, coalition building, laws and regulations, and community participation can be the first solutions for establishment of telemedicine in Iran.
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8. Scott-Kruse C, Karem P, Shifflett K, et al (2016). Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare, 24:4–12. doi:10.1177/1357633X16674087
9. LeRouge C, Garfield M (2013). Crossing the telemedicine chasm: Have the US barriers to widespread adoption of telemedicine been significantly reduced. Int J Environ Res Public Health, 10(12):6472-6484. doi:10.3390/ijerph10126472
10. Alghatani KM (2016). Telemedicine implementation: Barriers and recommendations. J Sci Res Stud, 3:140–145.
11. Skoczylas P (2016). Utilizing telemedical solutions in the efficient functioning of a health care system. J Health Study Med, 2:69–82.
12. Nittari G, Khuman R, Baldoni S, et al (2020). Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemed e-Health, 26:1427–1437. doi:10.1089/tmj.2019.0158
13. Keshvardoost S, Dehnavieh R, Bahaadinibeigy K (2021). The necessity of implementing telemedicine systems in the Islamic Republic of Iran. East Mediterr Health J, 27(2):113-115. doi:10.26719/emhj.21.001
14. Khalifehsoltani SN, Gerami MR (2010). E-health challenges, opportunities and experiences of developing countries. 2010 International Conference on e-Education, e-Business, e-Management and e-Learning, Sanya, China, pp.264-268. doi: 10.1109/IC4E.2010.119
15. Furlepa K, Tenderenda A, Kozłowski R (2022). Recommendations for the Development of Telemedicine in Poland Based on the Analysis of Barriers and Selected Telemedicine Solutions. Int J Environ Res Public Health, 19(3):1221. doi:10.3390/ijerph19031221
16. Abd Ghani MK, Jaber MM, Suryana N (2015). Barriers faces telemedicine implementation in the developing countries: toward building Iraqi telemedicine framework. ARPN J Eng Appl Sci, 10(4):1562-1567.
17. Omboni S, Caserini M, Coronetti C (2016). Telemedicine and M-Health in Hypertension Management: Technologies, Applications and Clinical Evidence. High Blood Press. Cardiovasc Prev, 23:187-196. doi:10.1007/s40292-016-0143-6
18. Trettel A, Eissing L, Augustin M (2017). Telemedicine in dermatology: Findings and experiences worldwide: A systematic literature review. J Eur Acad Dermatol Venereol, 32:215–224. doi:10.1111/jdv.14341
19. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med, 151(4):264-269. doi:10.7326/0003-4819-151-4-200908180-00135
20. Yazdi-Feyzabadi V, Mehrolhassani MH, Zolala F, Haghdoost A, Oroomiei N (2019). Determinants of risky sexual practice, drug abuse and alcohol consumption in adolescents in Iran: a systematic literature review. Reprod Health, 16(1):1-0. doi:10.1186/s12978-019-0779-5
21. Terry G, Hayfield N, Clarke V, Braun V (2017). Thematic analysis. In: The SAGE handbook of qualitative research in psychology. SAGE Publications Ltd, 1st, New York, USA, pp.17-37. doi:10.4135/9781526405555
22. World Health Organization (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. 2nd ed. Geneva: WHO Press. Switzerland.
23. Mousavi SM, Takian A, Tara M (2021). Sixteen years of eHealth experiences in Iran: a qualitative content analysis of national policies. Health Res. Policy Syst, 19(1):1-5. doi:10.1186/s12961-021-00795-x
24. Ameri A, Salmanizadeh F, Keshvardoost S, Bahaadinbeigy K (2020). Investigating pharmacists’ views on telepharmacy: prioritizing key relationships, barriers, and benefits. J Pharm Technol, 36(5):171-8. doi:10.1177/8755122520931442
25. Rezaei P, Maserrat E, Torab-Miandoab A (2017). Specialist Physicians’ Perspectives about Telemedicine and Barriers to Using it in Tabriz Teaching Hospitals. Iran South Med J, 20(6):562-572.
26. Sheikhtaheri A, Saravani-Aval S, Farzi J, Bagheri S (2018). A feasibility study on the implementation of teleconsultation in tuberculosis patients in Zabol City of Iran. Stud Health Technol Inform, 247:501-505. doi:10.3233/978-1-61499-852-5-501
27. Davari F (2018). Feasibility of Deploying Telemedicine System in Fatemeh Zahra Hospital of Isfahan. World journal of extensive management, 4(1): 24-34.
28. Azizi A, Sharifat Z (2017). Barriers to Telemedicine: Perspectives of the Administrators. Iran J Med Inform, 6(1):23-27. doi:10.24200/ijmi.v6i1.92
29. Nobakht S, Bagheri S, Mehraeen E, Shamsabadi AR (2018). The feasibility of telemedicine technology implementation in the selected hospitals of Iran. J Payavard Salamat, 12(1):25-33.
30. Eghbali Zarch ME, Montazeralfaraj R, Shamsi F, et al (2017). Feasibility of Telemedicine Deployment in Major Public Hospitals: A case study in Yazd. Evid based health policy manag econ, 1(2):94-102.
31. Sheikhtaheri A, Sarbaz M, Kimiafar K, Ghayour M, Rahmani S (2016). Awareness, Attitude and Readiness of in Mashhad, Iran. Stud Health Technol Inform, 228:142–146. doi:10.3233/978-1-61499-678-1-142
32. Doshmangir L, Esmaeil Zadeh H, Arab Zozani M (2015). Assessing the Strategic Position of Telemedicine Technology in Iran. J Manage Med Inform Sci, 2(2): 144-151.
33. Mehraeen E, Bagheri S, Karimi M (2016). Review of necessary infrastructures to telemedicine implementation in hospitals affiliated with Zabol University of Medical Sciences. J Paramed Sci Rehabil, 5(3):74-82. doi:10.22038/JPSR. 2016.7346
34. Shafiei Nikabadi M, Safavi Jahromi G (2015). Identifying and Analyzing the Barriers of Telemedicine Implementation in Iran. Health Inf Manage, 12(3):298-305.
35. Keshvari H, Haddadpoor A, Taheri B, Aghdak P, Nasri M (2015). Feasibility of Implementing Telemedicine According To the Elements of Strategic Planning In Isfahan University of Medical Sciences. Health Inf Manage, 12(5):625-635.
36. Keshvari H, Haddadpoor A, Taheri B, Nasri M, Aghdak P (2014). Survey determinant factors of telemedicine strategic planning from the managers and experts perspective in the health department, isfahan university of medical sciences. Acta Informatica Medica, 22(5):320-324. doi:10.5455/aim.2014.22.320-324
37. Salehahmadi Z, Hajialiasghari F (2013). Telemedicine in Iran: Chances and Challenges. World J Plast Surg, 2(1):18-25.
38. Sharifi M, Ayat M, Jahanbakhsh M, et al (2013). E-health implementation challenges in Iranian medical centers: a qualitative study in Iran. TELEMED E-HEALTH, 19(2):122-128. doi:10.1089/tmj.2012.0071
39. Esmailzadeh H, Doshmangir L, Tafazoli M (2013). Key factors influencing the use of telemedicine technology in Iran: Experts View Points. Teb o Tazkie, 22(3):51-58.
40. Nasiripour AA, Rahmani H, Radfar R, Najafbeigi R (2012). Effective elements on e-health deployment in Iran. Afr J Bus Manag, 6(16):5543-5550. doi: 10.5897/AJBM11.2791
41. Bastani P, Abolhasani N, Shaarbafchizadeh N (2014). Electronic Health in Perspective of Healthcare Managers: A Qualitative Study in South of Iran. Iran. J Public Health, 43(6):809-820.
42. Hosseini A, Moghaddasi H, Asadi F, Karimi M (2012). Feasibility Study of Implementing Telesurgery in Hospitals Affiliated to Tehran Universities of Medical Sciences, Iran. Health Information Management, 9(1):64-74.
43. Haghighi M, Alipour J, Mastaneh Z, Mouseli L (2010). Feasibility study of telemedicine implementation in Hormozgan university of medical sciences. Hormozgan Medical Journal, 2:128-37.
44. Bali S (2018). Barriers to Development of Telemedicine in Developing Countries. In: Telehealth. Ed,TF Heston. IntechOpen Publishing, 1st, London, United Kingdom. doi:10.5772/intechopen.81723
45. Al Shorbaji N (2008). E-health in the Eastern Mediterranean Region: a decade of challenges and achievements. East Mediterr Health J, 14:157-173.
46. Al-Samarraie H, Ghazal S, Alzahrani AI, Moody L (2020). Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations. Int J Med Inform, 141:104232. doi:10.1016/j.ijmedinf.2020.104232
47. LeRouge C, Garfield M (2013). Crossing the telemedicine chasm: Have the US barriers to widespread adoption of telemedicine been significantly reduced. Int J Environ Res Public Health, 10(12):6472-6484. doi:10.3390/ijerph10126472
48. Hassibian MR, Hassibian S (2016). Telemedicine acceptance and implementation in developing countries: benefits, categories, and barriers. Razavi Int J Med, 4(3):e38332. doi:10.17795/rijm38332
49. Saghaeiannejad-Isfahany S, Jahanbakhsh M, Shayan A (2015). Telemedicine operational feasibility in selected hospitals of Isfahan University of Medical Sciences in 1393. Int j health syst disaster manag, 3(4):189-194. doi:10.4103/2347-9019.162549
50. Saeedi Tehrani S, Noroozi M (2015). Telemedicine: benefits, disadvantages and ethical challenges. J Med Ethics Hist Med, 8(2):29-40.
51. Mirani N, Ayatollahi H, Haghani H (2012). A Survey on Barriers to the Development and Adoption of Electronic Health Records in Iran. J Health Organ Manag, 15(50): 65-75.
52. Mafi-Moradi S, Doshmangir L, Kabiri N (2019). Challenges and Opportunities of Telemedicine: A Narrative Review Study. Health Inf Manage, 15(6):294-299. doi:10.22122/him.v15i6.3683
2. World Health Organization (2012). National eHealth strategy toolkit. 1nd ed. Geneva: WHO Press. Switzerland.
3. The National eHealth Authority (2013). Making eHealth Work. 1nd ed. Copenhagen: pekema danmark press. Denmark.
4. Scott BK, Miller GT, Fonda SJ, et al (2020). Advanced digital health technologies for COVID-19 and future emergencies. Telemed e-Health, 26(10):1226–33. doi:10.1089/tmj.2020.0140
5. Mousavi SM, Takian A, Tara M (2018). Design and validity of a questionnaire to assess national eHealth architecture (NEHA): a study protocol. BMJ Open, 8(12):e022885. doi:10.1136/bmjopen-2018-022885
6. OECD Organization, European Union (2016). Health at a Glance: Europe 2016 - State of Health in the EU Cycle. 4nd ed. Paris: OECD Publishing. France. doi.org/10.1787/9789264265592-en
7. De-Souza CHA, Morbeck, RA, Steinman M (2017). Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil. Telemed e-Health, 23:527–532. doi:10.1089/tmj.2016.0158
8. Scott-Kruse C, Karem P, Shifflett K, et al (2016). Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare, 24:4–12. doi:10.1177/1357633X16674087
9. LeRouge C, Garfield M (2013). Crossing the telemedicine chasm: Have the US barriers to widespread adoption of telemedicine been significantly reduced. Int J Environ Res Public Health, 10(12):6472-6484. doi:10.3390/ijerph10126472
10. Alghatani KM (2016). Telemedicine implementation: Barriers and recommendations. J Sci Res Stud, 3:140–145.
11. Skoczylas P (2016). Utilizing telemedical solutions in the efficient functioning of a health care system. J Health Study Med, 2:69–82.
12. Nittari G, Khuman R, Baldoni S, et al (2020). Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemed e-Health, 26:1427–1437. doi:10.1089/tmj.2019.0158
13. Keshvardoost S, Dehnavieh R, Bahaadinibeigy K (2021). The necessity of implementing telemedicine systems in the Islamic Republic of Iran. East Mediterr Health J, 27(2):113-115. doi:10.26719/emhj.21.001
14. Khalifehsoltani SN, Gerami MR (2010). E-health challenges, opportunities and experiences of developing countries. 2010 International Conference on e-Education, e-Business, e-Management and e-Learning, Sanya, China, pp.264-268. doi: 10.1109/IC4E.2010.119
15. Furlepa K, Tenderenda A, Kozłowski R (2022). Recommendations for the Development of Telemedicine in Poland Based on the Analysis of Barriers and Selected Telemedicine Solutions. Int J Environ Res Public Health, 19(3):1221. doi:10.3390/ijerph19031221
16. Abd Ghani MK, Jaber MM, Suryana N (2015). Barriers faces telemedicine implementation in the developing countries: toward building Iraqi telemedicine framework. ARPN J Eng Appl Sci, 10(4):1562-1567.
17. Omboni S, Caserini M, Coronetti C (2016). Telemedicine and M-Health in Hypertension Management: Technologies, Applications and Clinical Evidence. High Blood Press. Cardiovasc Prev, 23:187-196. doi:10.1007/s40292-016-0143-6
18. Trettel A, Eissing L, Augustin M (2017). Telemedicine in dermatology: Findings and experiences worldwide: A systematic literature review. J Eur Acad Dermatol Venereol, 32:215–224. doi:10.1111/jdv.14341
19. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med, 151(4):264-269. doi:10.7326/0003-4819-151-4-200908180-00135
20. Yazdi-Feyzabadi V, Mehrolhassani MH, Zolala F, Haghdoost A, Oroomiei N (2019). Determinants of risky sexual practice, drug abuse and alcohol consumption in adolescents in Iran: a systematic literature review. Reprod Health, 16(1):1-0. doi:10.1186/s12978-019-0779-5
21. Terry G, Hayfield N, Clarke V, Braun V (2017). Thematic analysis. In: The SAGE handbook of qualitative research in psychology. SAGE Publications Ltd, 1st, New York, USA, pp.17-37. doi:10.4135/9781526405555
22. World Health Organization (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. 2nd ed. Geneva: WHO Press. Switzerland.
23. Mousavi SM, Takian A, Tara M (2021). Sixteen years of eHealth experiences in Iran: a qualitative content analysis of national policies. Health Res. Policy Syst, 19(1):1-5. doi:10.1186/s12961-021-00795-x
24. Ameri A, Salmanizadeh F, Keshvardoost S, Bahaadinbeigy K (2020). Investigating pharmacists’ views on telepharmacy: prioritizing key relationships, barriers, and benefits. J Pharm Technol, 36(5):171-8. doi:10.1177/8755122520931442
25. Rezaei P, Maserrat E, Torab-Miandoab A (2017). Specialist Physicians’ Perspectives about Telemedicine and Barriers to Using it in Tabriz Teaching Hospitals. Iran South Med J, 20(6):562-572.
26. Sheikhtaheri A, Saravani-Aval S, Farzi J, Bagheri S (2018). A feasibility study on the implementation of teleconsultation in tuberculosis patients in Zabol City of Iran. Stud Health Technol Inform, 247:501-505. doi:10.3233/978-1-61499-852-5-501
27. Davari F (2018). Feasibility of Deploying Telemedicine System in Fatemeh Zahra Hospital of Isfahan. World journal of extensive management, 4(1): 24-34.
28. Azizi A, Sharifat Z (2017). Barriers to Telemedicine: Perspectives of the Administrators. Iran J Med Inform, 6(1):23-27. doi:10.24200/ijmi.v6i1.92
29. Nobakht S, Bagheri S, Mehraeen E, Shamsabadi AR (2018). The feasibility of telemedicine technology implementation in the selected hospitals of Iran. J Payavard Salamat, 12(1):25-33.
30. Eghbali Zarch ME, Montazeralfaraj R, Shamsi F, et al (2017). Feasibility of Telemedicine Deployment in Major Public Hospitals: A case study in Yazd. Evid based health policy manag econ, 1(2):94-102.
31. Sheikhtaheri A, Sarbaz M, Kimiafar K, Ghayour M, Rahmani S (2016). Awareness, Attitude and Readiness of in Mashhad, Iran. Stud Health Technol Inform, 228:142–146. doi:10.3233/978-1-61499-678-1-142
32. Doshmangir L, Esmaeil Zadeh H, Arab Zozani M (2015). Assessing the Strategic Position of Telemedicine Technology in Iran. J Manage Med Inform Sci, 2(2): 144-151.
33. Mehraeen E, Bagheri S, Karimi M (2016). Review of necessary infrastructures to telemedicine implementation in hospitals affiliated with Zabol University of Medical Sciences. J Paramed Sci Rehabil, 5(3):74-82. doi:10.22038/JPSR. 2016.7346
34. Shafiei Nikabadi M, Safavi Jahromi G (2015). Identifying and Analyzing the Barriers of Telemedicine Implementation in Iran. Health Inf Manage, 12(3):298-305.
35. Keshvari H, Haddadpoor A, Taheri B, Aghdak P, Nasri M (2015). Feasibility of Implementing Telemedicine According To the Elements of Strategic Planning In Isfahan University of Medical Sciences. Health Inf Manage, 12(5):625-635.
36. Keshvari H, Haddadpoor A, Taheri B, Nasri M, Aghdak P (2014). Survey determinant factors of telemedicine strategic planning from the managers and experts perspective in the health department, isfahan university of medical sciences. Acta Informatica Medica, 22(5):320-324. doi:10.5455/aim.2014.22.320-324
37. Salehahmadi Z, Hajialiasghari F (2013). Telemedicine in Iran: Chances and Challenges. World J Plast Surg, 2(1):18-25.
38. Sharifi M, Ayat M, Jahanbakhsh M, et al (2013). E-health implementation challenges in Iranian medical centers: a qualitative study in Iran. TELEMED E-HEALTH, 19(2):122-128. doi:10.1089/tmj.2012.0071
39. Esmailzadeh H, Doshmangir L, Tafazoli M (2013). Key factors influencing the use of telemedicine technology in Iran: Experts View Points. Teb o Tazkie, 22(3):51-58.
40. Nasiripour AA, Rahmani H, Radfar R, Najafbeigi R (2012). Effective elements on e-health deployment in Iran. Afr J Bus Manag, 6(16):5543-5550. doi: 10.5897/AJBM11.2791
41. Bastani P, Abolhasani N, Shaarbafchizadeh N (2014). Electronic Health in Perspective of Healthcare Managers: A Qualitative Study in South of Iran. Iran. J Public Health, 43(6):809-820.
42. Hosseini A, Moghaddasi H, Asadi F, Karimi M (2012). Feasibility Study of Implementing Telesurgery in Hospitals Affiliated to Tehran Universities of Medical Sciences, Iran. Health Information Management, 9(1):64-74.
43. Haghighi M, Alipour J, Mastaneh Z, Mouseli L (2010). Feasibility study of telemedicine implementation in Hormozgan university of medical sciences. Hormozgan Medical Journal, 2:128-37.
44. Bali S (2018). Barriers to Development of Telemedicine in Developing Countries. In: Telehealth. Ed,TF Heston. IntechOpen Publishing, 1st, London, United Kingdom. doi:10.5772/intechopen.81723
45. Al Shorbaji N (2008). E-health in the Eastern Mediterranean Region: a decade of challenges and achievements. East Mediterr Health J, 14:157-173.
46. Al-Samarraie H, Ghazal S, Alzahrani AI, Moody L (2020). Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations. Int J Med Inform, 141:104232. doi:10.1016/j.ijmedinf.2020.104232
47. LeRouge C, Garfield M (2013). Crossing the telemedicine chasm: Have the US barriers to widespread adoption of telemedicine been significantly reduced. Int J Environ Res Public Health, 10(12):6472-6484. doi:10.3390/ijerph10126472
48. Hassibian MR, Hassibian S (2016). Telemedicine acceptance and implementation in developing countries: benefits, categories, and barriers. Razavi Int J Med, 4(3):e38332. doi:10.17795/rijm38332
49. Saghaeiannejad-Isfahany S, Jahanbakhsh M, Shayan A (2015). Telemedicine operational feasibility in selected hospitals of Isfahan University of Medical Sciences in 1393. Int j health syst disaster manag, 3(4):189-194. doi:10.4103/2347-9019.162549
50. Saeedi Tehrani S, Noroozi M (2015). Telemedicine: benefits, disadvantages and ethical challenges. J Med Ethics Hist Med, 8(2):29-40.
51. Mirani N, Ayatollahi H, Haghani H (2012). A Survey on Barriers to the Development and Adoption of Electronic Health Records in Iran. J Health Organ Manag, 15(50): 65-75.
52. Mafi-Moradi S, Doshmangir L, Kabiri N (2019). Challenges and Opportunities of Telemedicine: A Narrative Review Study. Health Inf Manage, 15(6):294-299. doi:10.22122/him.v15i6.3683
| Files | ||
| Issue | Vol 54 No 4 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Telemedicine Telehealth Telecare E-health M-health Iran | ||
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How to Cite
1.
Mehrolhassani MH, Yazdi-Feyzabadi V, Dehnavieh R, Bahaadinbeigy K, Kargar M. Barriers to Telemedicine Establishment in Iran: A Systematic Review. Iran J Public Health. 2025;54(4):739-750.
