Table 1.

An example of coding and development of categories and themes

Meaning units	Coding	Subthemes	Themes
“On several occasions, I’ve seen some of my colleagues get confused when they want to use telecardiogram and don’t have the skills to operate the device properly. Even some of the personnel who are familiar with telemedicine have difficulty using the device. Knowledge of telemedicine alone is not enough, and you need to have the necessary skills as well. If the emergency care personnel can’t use their knowledge in practice and use their skills, they will not be competent enough.” (participant 15)	Lack of clinical skill in using the tele-electrocardiogram Lack of skill in interpreting ECG	Lack of clinical skill in telecardiology	Professional barriers
“Sometimes, we are dispatched to help a patient with a cardiac issue in the early hours, like three o’clock in the morning; after cardiac monitoring, we send the patient’s electrocardiogram to a cardiologist to get counsel, but, unfortunately, no one is available, and we get no counsel. This is a real issue, and we can’t know if we should administer anticoagulants, such as Plavix and aspirin, or not.” (participant 7)	Non-availability of cardiologist for consultation	Serious lack of cardiologists available for medical counseling	Organizational management barriers