Table.

Barriers for the adoption of telemedicine and proposed mitigation strategies

Perspective	Barriers	Mitigation Strategies
Patient	• Perception of incomplete care • Perception of lack of rapport with the provider or that the visit is impersonal • Lack of equipment (computer, smartphone, or tablet) • Technology limitations and language barriers • No broad-band internet	• Education and reassurance • Provide regular feedback • Patients’ regular feedback • Resources for real-time troubleshooting and technical support • Accommodations for patients with language barriers • Government support for a reliable internet connection
Provider	• Licensing restrictions • Lack of physical exam to assist in decision making • Inconsistent reimbursement • Concern for patient privacy • Technology limitations	• Institutional support for multistate licensing • Education and training • Observational physical exam training • Institutional contract agreement with insurers • Institutional support to provide appropriate equipment, technology and staff support • Venue to allow providers to provide regular feedback
Institutional	• Lack of infrastructure • Lack of personnel staffing • Unclear cost/benefit ratio • Lack of buy-in • Inconsistent reimbursement	• Infrastructure investment • staffing support • Assist providers in obtaining state licensing to improve involvement and reimbursement • Advocacy for promotion of telemedicine with government agencies
Regulatory	• Insurer reimbursement limitations • State licensing restrictions • Regulatory limitations • Consents/prescription regulations	• Advocacy for global licensing • Support for telemedicine by public and private insurers • Homogenize and streamline regulations • Exemption to transplant centers