Table 1.

Facilitators and barriers to telehealth based on the non-adoption, abandonment, scale-up, spread, sustainability (NASSS) framework ⁶³ and adopted to rheumatology.

NASSSdomain	Content, NASSS domain	Identified facilitators and barriers within rheumatology a
		Facilitator	Barrier
The condition	What is the complexity of the illness, what are the sociocultural factors and comorbidities?	• Increased accessibility to specialist care, especially for people living in remote areas • Reduced waiting time	• Lack of physical contact, no body language communication • No possibility of performing tests and clinical examinations which may lead to postponement of treatment decisions
The technology	What are the key features of the technology; off-the-shelf and already installed or not yet developed? Is it simple telehealth or complicated, direct or indirect measurements?	• Simple telehealth, easy to use, high degree of availability Video calls • Possibility of including assistive technology (live captioning, medical interpreter) • Previous experience with telehealth Training of people with RMDs and clinicians	• Lack of knowledge and confidence with technology Resistance to technology • No suitable equipment No access to Internet Data security concerns
The value position, developers	What is the developer’s business case, desirability, efficacy, cost-effectiveness and safety?	• Cost savings for healthcare services	• Reimbursement issues (insurance companies)
The adopters	Will there be change of staff roles, and what are the patient expectations?	• Good familiarity with clinicians • Good past treatment experiences • High motivation and engagement • Involvement of family members • High flexibility	• Lack of training of clinicians Unclear work procedures and expectations among clinicians Lack of privacy
The organization	What is the capacity to innovate, readiness for change and who is in charge for implementation?		• Lack of co-ordination and unclear responsibility for implementation

RMDs, rheumatic and musculoskeletal diseases.

^aThis list is not exhaustive.