Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings

Abstract

AbstractTelemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at healthcare facilities. However, its adoption in healthcare is not entirely realised due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian healthcare system, observed at the infrastructural, socio-cultural, regulatory and financial levels, from the perspectives of healthcare providers, patients, patient caregivers, society, health organisations and the government. This review complies with the current PRISMA-P protocol. 1200 peer-reviewed studies published from December 2016 to December 2021 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE and PsycInfo databases were considered for the title and abstract screening, after which 157 articles were chosen for the full-text review. In the end, 26 studies were selected for data synthesis. Data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), poor infrastructure, and lack of ICT training were considered significant barriers to implementing telemedicine. However, reduced healthcare delivery costs, improved patient access to healthcare in remote areas, and reduced patient waiting times all helped promote telemedicine implementation. The review outcomes also revealed that the barriers and facilitators at the regulatory and financial level largely influenced the adoption of telemedicine systems in India, with 59% (n=20) articles citing a reduction in healthcare delivery costs as the critical facilitator and 59% citing fear of violation of patient privacy and security as the significant barrier.