Table 3.

Challenges of emergency department telemedicine

Challenge	Source	Ratio
Technical issues and difficulties	(Brainard et al. 2016; Gattu et al. 2016; Pak and Pak 2015; Rogers et al. 2017; Guevorkian 2017; Culmer et al. 2019)	6/18
Legislative, ethical and policy issues	(Eder et al. 2018; Gattu et al. 2016; Marsh-Feiley et al. 2018; Salmoiraghi and Hussain 2015; Culmer et al. 2019)	5/18
Protecting patient privacy, confidentiality and security	(Gattu et al. 2016; Marsh-Feiley et al. 2018; Pak and Pak 2015)	3/18
Prolonged consultation time with telemedicine	(Gattu et al. 2016; Marsh-Feiley et al. 2018; Pak and Pak 2015)	3/18
Scarce and limited literature on technology implementation	(Kelton et al. 2018; Kimmel et al. 2019; Salmoiraghi and Hussain 2015)	3/18
Lack of cooperation from other departments	(Eder et al. 2018; Winburn et al. 2018)	2/18
Loss of skill in rural physician	(Kelton et al. 2018; Pak and Pak 2015)	2/18
Incompatible pre-existing health systems	(Kelton et al. 2018; Pak and Pak 2015)	2/18
Increased anxiety in hub physician	(Kelton et al. 2018; Pak and Pak 2015)	2/18
Possible loss of critical data	(Marsh-Feiley et al. 2018; Pak and Pak 2015)	2/18
Synchronizing the field of telemedicine and emergency care	(Bashshur et al. 2016; Pak and Pak 2015)	2/18
Increased workload in low staff areas	(du Toit et al. 2019; Boggan et al. 2020)	2/18
Lower inclination of rural residents for participation	(Brainard et al. 2016; Culmer et al. 2019)	2/18
Financial support	(Ward et al. 2015; Culmer et al. 2019)	2/18
Additional time needed for setting up equipment	(Pak and Pak 2015)	1/18
Disagreement between diagnosis and management between physician	(Pak and Pak 2015)	1/18
User support	(du Toit et al. 2019)	1/18
Difficulty of providing care in remote rural EDs	(du Toit et al. 2019)	1/18
Implementation costs	(Rogers et al. 2017)	1/18
Increased complexity of cases	(Ward et al. 2015)	1/18
Difficult system maintenance	(Kimmel et al. 2019)	1/18