We conducted a systematic review of the literature by extracting data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. Searches were performed between 6 and 10 June 2016. The keywords used for the research in this study were barriers, adoption, implementation, telemedicine, tele care, telecare, tele health, telehealth, mobile health, mHealth, m-Health, eHealth, and e-Health. The terms used in the searches were slightly different between the two databases, primarily because the two databases index differently. Figure 1 illustrates the search process with inclusion and exclusion criteria. As depicted, the exact search phrase in CINAHL was ‘((Barriers) AND (Adoption OR Implementation)) AND (“Telemedicine” OR “Tele care” OR “Mobile health” OR “eHealth” OR “mhealth” OR “m-health” OR “e-health” OR “Telecommunication” OR “telehealth” OR “Self care”)’. In PubMed (MEDLINE), all the sub-terms used in the CINAHL search were already nested under telemedicine in the PubMed Medical Subject Headings (MeSH) of telemedicine. Boolean operators and quotation marks were used in the search process to capture variations in the lexicon and to identify the desired intersection of telemedicine and barriers.

Literature search with inclusion and exclusion criteria.

When the above-mentioned keywords were used, 226 articles from CINAHL Complete and 241 articles from PubMed were obtained. The articles were filtered using the publication dates ranging from the year 2011 to 2016 to evaluate the most recent barriers in implementing telemedicine and telehealth. The inclusion criteria used for PubMed were: free full-text, English language, and humans, focusing mainly on articles from MEDLINE. The inclusion criteria from the CINAHL-Complete database were: full text, English language, humans, academic journals, and references available. We excluded MEDLINE from CINAHL complete because the search criteria for PubMed included only MEDLINE articles. After applying the filters to both the PubMed and CINAHL Complete databases, the search was narrowed down to 56 and 10 articles, respectively. A literature matrix was created to list all the articles; the articles were then divided between reviewers so that at least two reviewers screened each abstract. Reviewers used a spreadsheet to compile their recommendations on whether the article was germane to this review, and a consensus meeting was called to share notes. Articles deemed not germane by at least two reviewers were excluded, and the articles for which the authors’ recommendations conflicted were discussed to reach consensus. The references from the remaining articles were visually scanned to identify common studies that were not already captured. This process added one additional article. Through our process, 30 articles were selected for the systematic literature review. These 30 articles were divided between the reviewers so that at least two reviewers read each article and made notes to identify barriers. A second consensus meeting was called to compare notes and to reach agreement on the barriers identified. We identified barriers by country and organized them into several bar charts organized by frequency of occurrence in the literature.