Table 2 Summary of barriers and facilitators identified in the included quantitative and qualitative studies, using Chang’s framework

Human Dimension

Healthcare Providers

1.1

Comfort with workflow

“Providers were concerned about negative impacts on their clinic flow” [22]

n = 1

[22]

n = 0

n = 0

1.2

Comfort with patient communication

“Many expressed concerns about their needs being assessed over the telephone, including doubts about the ability of unknown doctors to make accurate diagnoses in these circumstances. […] ‘I don’t think it is advisable to talk to the doctor over the phone about what you are suffering with and what the symptoms are and so on. I think it is most important that a doctor sees you’. (Male, group 4.)” [34]

n = 5

[21, 30, 33, 34, 37]

n = 1

[22]

n = 1

[27]

1.3

Comfort with provider interaction

“There was also the mutually perceived incidental benefit of opportunity for doctor-nurse communication, often carrying over beyond individual cases” [37]

n = 0

n = 1

[37]

n = 2

[20, 33]

1.4

Expertise with technology

“Nurses with high technology experience (e.g., computers, microwaves, Skype, tablets) (n = 41) had a significantly lower negative affect score related to the use of home telehealth” [36]

n = 0

n = 2

[20, 33]

n = 2

[22, 36]

1.5

Education and training

“It was clear that this rather public learning process had been uncomfortable for some of the nurses involved” [37]

n = 1

[37]

n = 1

[30]

n = 0

1.6

Resistance to change

“Undoubtedly, this was related to the local team leader’s role in initiating the development, but it was clear that her colleagues also found the development interesting and worthwhile” [37]

n = 0

n = 0

n = 3

[20, 22, 37]

Patients & Caregivers

2.1

Disease characteristics / sociodemographic characteristics

“Older adults 'described ‘The aging body as a barrier’ with impaired practical abilities such as trembling fingers or impaired vision or hearing” [31]

n = 1

[23]

n = 13

[21, 22, 26,27,28, 30,31,32,33,34, 36, 37]

n = 0

2.2

Technology skills and knowledge

“Older people believed that they were not able to accomplish certain technological tasks (low self-efficacy), but discovered that they actually were able to do so or could do so after a small suggestion on how to proceed” [36]

n = 7

[22,23,24, 28, 32, 33, 36]

n = 1

[31]

n = 2

[34, 38]

2.3

User habits/preferences

“’I don’t feel this can work and doesn’t feel real to me. I prefer going to a doctor in a clinic, let the doctor see myself through his own eyes’ “ [32]

n = 6

[22, 25, 26, 29, 33, 36]

n = 8

[19, 24, 28, 30,31,32, 34, 37]

n = 1

[27]

2.4

Location/travel time

“One participant felt that e-consultation could break down geographical barriers that potentially reduce access to healthcare […]

'I don't have to waste my time coming in for check-ups'” [32]

n = 0

n = 5

[22, 27, 28, 37]

n = 7

[21, 29,30,31,32,33,34]

2.5

Patient awareness / support

“Although some participants were against e-consultation because of difficulty with internet access, they would consider using the service with the help from family members and friends, as this participant described: ‘It [e-consultation] is only feasible if I can receive help from the younger ones, helping me to use the internet…’ [Fishermen, retired, female, age above 65]” [32]

n = 1

[33]

n = 1

[32]

n = 1

[36]

2.6

Technology equipment

“26 scheduled visits were cancelled due to lack of patients’ telecommunications devices” [29]

n = 6

[24, 28, 29, 32, 33, 36]

n = 0

n = 0

2.7

Medical cost (out-of-pocket)

“Relying on paid caregivers often meant using the aides’ own phone and data plan. As one provider asked, ‘is someone reimbursing [the aide] for that [data]? Is there Wi-Fi in the home? Do they [the aide] even have a smartphone?’ (CD, Practice 6)” [33]

n = 2

[31, 33]

n = 3

[20, 30, 32]

n = 0

System Dimension

Organization

3.1

Leadership

“Undoubtedly, this was related to the local team leader’s role in initiating the development” [37]

n = 0

n = 0

n = 1

[37]

3.2

Change management

“While participants generally expressed pride in how quickly they and their patients adapted, they also described limitations […] including the need to rapidly consent patients, set up patient portal accounts, and learn a new system quickly” [33]

n = 0

n = 1

[33]

n = 0

3.3

Budget

N/A

n = 0

n = 0

n = 0

3.4

Workflow reengineering

“Instead of providing a way to maintain contact with patients without requiring them to appear in clinic frequently, telephone appointments became simply an additional service” [19]

n = 3

[21, 30, 31]

n = 1

[19]

n = 4

[27, 32, 33, 37]

3.5

Organizational culture

“They also had thoughts about differences between the organizations. One of the participants wondered why short text message reminders are common in the dental care but not in primary care” [31]

n = 2

[31, 32]

n = 0

n = 0

3.6

Hospital information systems

N/A

n = 0

n = 0

n = 0

3.7

Training and support

N/A

n = 0

n = 0

n = 0

Technology

4.1

Reliability of technology

“Some participants demanded high internet stability for the service, as they felt it would be useless if the technology itself was unreliable: ‘If the computer system is slow then it [e-consultation] isn’t helpful. It will take longer if the computer system constantly breaks down and need to spend hours to recover.’” [32]

n = 5

[22, 31,32,33, 36]

n = 2

[30, 37]

n = 0

4.2

Storage

N/A

n = 0

n = 0

n = 0

4.3

System speed

N/A

n = 0

n = 0

n = 0

4.4

User interface / intended use /usability

“Overall, providers noted the diversity of options (institutional platforms, other HIPAA-compliant commercial platforms, and consumer platforms) allowed greater access to patients than would otherwise have been possible. Providers appreciated the ease of texting images of a skin condition or meeting quickly by FaceTime and hoped this flexibility could continue as privacy rules were enforced again. ‘We just did whatever we really felt was needed for that patient, and it’s going to be spoiled going back to the regular [institutional platform] way’, noted one social worker” [33]

n = 1

[34]

n = 9

[21, 27,28,29,30,31, 33, 36, 37]

n = 0

4.5

Data quality

“GPs [General Practitioners] reported some sound issues, difficulties seeing rashes and skin problems.” [37]

n = 1

[37]

n = 0

n = 0

4.6

Transmission

“Having digital access to information about the medication was described as another potential advantage” [31]

n = 0

n = 0

n = 1

[31]

4.7

Interoperability

“The main issue that the participants talked about was that there was ‘Poor communication between health care organizations’ IT systems’. As no organization was fully updated with all the information, the participants expressed ‘disappointment over poor IT systems’” [31]

n = 1

[31]

n = 0

n = 1

[33]

4.8

Information security

““I think e-consultation opens up an opportunity for criminal activities if safety measures [online security] are not taken.’ [Police, retired, male, age above 65]” [32]

n = 0

n = 2

[31, 32]

n = 0

Environment Dimension

Society

5.1

3rd party payers

“The accelerated pace of change driven by the pandemic and resulting changes in regulation and reimbursement have also allowed for rapid HBPC practice innovations that would not otherwise have been possible.” [33]

n = 0

n = 0

n = 1

[33]

5.2

Technology infrastructure

N/A

n = 0

n = 0

n = 0

5.3

Reimbursement

N/A

n = 0

n = 0

n = 0

5.4

Insurance fee schedule

N/A

n = 0

n = 0

n = 0

5.5

Social norms and values / temporal trends

N/A

n = 0

n = 0

n = 0

Rules/Policy

6.1

Medical liability

N/A

n = 0

n = 0

n = 0

6.2

Practice certification and license

N/A

n = 0

n = 0

n = 0

6.3

Governmental authority

“Governmental regulations in the establishment and running of e-consultation services would enhance participants’ trust in the service.’As long as the government is at the back of the service [e-consultation], I would then have confidence in it.’ [Domestic helper, retired, female, age 40–65]” [32]

n = 0

n = 0

n = 1

[32]

6.4

Privacy and security rules

“Providers appreciated the ease of texting images of a skin condition or meeting quickly by FaceTime and hoped this flexibility could continue as privacy rules were enforced again. ‘We just did whatever we really felt was needed for that patient, and it’s going to be spoiled going back to the regular [institutional platform] way’, noted one social worker” [33]

n = 0

n = 1

[33]

n = 0

6.5

Interface standards

N/A

n = 0

n = 0

n = 0