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Open research questions in Telemedicine and Telehealth Implementation

95 unresolved questions extracted from the limitations and future-work sections of 1,567 Telemedicine and Telehealth Implementation papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Background: Telepsychiatry expanded rapidly during the COVID-19 pandemic to support continuity of psychiatric care, although its long-term durability following the expiration of pandemic-era policies remains uncertain.

    Sustained Utilization of Video-Based Outpatient Psychiatry Visits Following the COVID-19 Public Health Emergency at an Academic Health Center · 2026 · DOI

  • For the race/ethnicity variable, we observed a lower likelihood of the Other, Non-Hispanic Group to utilize telehealth services. This group includes individuals with diverse racial backgrounds that do not fit into a stan- dard category. It is important to consider that cultural or linguistic factors can be a significant reason for a lower The limitations associated with this study include self-re- ported surveys, vastness of area represented, limited control over study design, and difficulty exploring com- plex phenomena. The responses in the survey is limited to those who are willing and able to respond. This led to some sub-groups having more representation than Şimşir İsmail et al.Acıbadem Univ. Sağlık Bilim. Derg. 2026 others. This survey was a nation-wide survey. While this was useful to gain perspectives on a national scale, it pre- vented a deeper understanding on the regional impact that a certain area may have on a patient population. Since this study was done quantitively, the study contains limited outcomes. This means that the respondents for the data faced limited options for their responses, based on the questionnaire made by the survey. Lastly, this study is limited by the inability to further study the complexity be- hind why a patient population would specially be facing barriers to care. It was outlined in the discussion that there are multiple drivers as to why an individual would not be able to receive care and this study is limited on studying the relationship between each variable. This study is lim- ited by its cross-sectional nature and overall reliance on self-reported data.

    Telehealth Disparities, Exploring the Impact of Socioeconomic Status on Access, and Utilization · 2026 · DOI

  • This narrative review has several limitations that should be acknowledged when interpreting its findings and recommendations. First, the rapid pace of technological development in telehealth and AI means that some included studies may not reflect the most current technological capabilities or implementation experiences. The field evolves quickly, and evidence from older studies may have limited applicability to current practice. Second, the heterogeneity of rural settings across countries and healthcare systems limits the generalizability of regulatory inconsistencies, and financial constraints. Evidence indicates that context-specific adaptation, comprehensive legal frameworks, and sustained investment in infrastructure and specific implementation strategies. Rural communities in developed countries face different challenges than those in low- and middle-income countries, and successful approaches in one capacity-building are essential for sustainable success. Legal and regulatory frameworks must evolve to address cross-jurisdictional licensing, data privacy protection, and professional accountability context may not translate directly to others. Third, the narrative review methodology, while providing a comprehensive synthesis across disciplines, lacks a systematic approach and bias assessment while ensuring equitable access to technological benefits. Public– private partnerships and international collaborations will be crucial for scaling successful models and sharing best practices across of systematic reviews. The selection of the included studies may reflect author bias, and the synthesis may not capture all relevant evidence in the field. Additionally, much of the available evidence diverse settings. Looking forward, achieving the transformative potential of these technologies requires a collective commitment from policymakers, healthcare providers, technology developers, comes from pilot programs or short-term implementations, limiting our understanding of long-term sustainability and outcomes. The lack of robust economic evaluations across studies makes it difficult to comprehensively assess cost-effectiveness. and communities. Success depends not only on technological innovation but also on comprehensive approaches that address the social determinants of health, cultural factors, and economic barriers. Finally, the focus on published literature may introduce publication bias, potentially overemphasize successful implementations while under-reporting challenges or failed programs. Grey literature and unpublished experiences may contain valuable insights that are not captured in this review. Future research should address these limitations through systematic reviews of specific implementation aspects, long-term outcome studies, and comprehensive economic evaluations of rural digital health programs.

    Legal and regulatory pathways for telehealth and artificial intelligence in rural health care: implications for access, ethics, and global health equity · 2026 · DOI

  • Several limitations warrant consideration. First, our search was primarily limited to English-language sources and those with available translations, potentially missing impor- tant non-Anglophone regulations despite translation efforts. The predominance of high-income jurisdictions (71.1%) in our sample limits generalizability to low- and middle- income settings. Second, rapid telemedicine regulatory evo- lution means some information may have been superseded by newer legislation between data collection and publica- tion. Third, we examined regulations as written rather than implemented, unable to capture enforcement variations or practical interpretations. Fourth, heterogeneity of source types—ranging from binding legislation to professional guidelines—complicated direct comparisons. Fifth, our focus on documentation requirements may not fully capture the broader regulatory ecosystem influencing telemedicine practice. Finally, the regulatory intensity score, while inno- vative, requires external validation in diverse healthcare contexts to confirm weighting validity. Specifically, the score weighting inherently reflects value judgments about what constitutes regulatory maturity, and may systematically favor jurisdictions with prescriptive (civil law) regulatory traditions over those employing principles-based (common law) frameworks. Validation against objective outcomes such as patient safety metrics, malpractice claims incidence, and quality indicators would strengthen the score’s utility for cross-jurisdictional comparison [26, 27].

    Telemedicine documentation in neurology and telestroke: a global scoping review · 2026 · DOI

  • To address these barriers, municipal clinics should prioritise infrastructure upgrades, sustained funding and ongoing training to boost staff and care user digital skills. Implementing adaptable, secure and interoperable digital systems will improve data sharing and streamline operations across departments. A tool implementation strategy should address resource gaps and service integration issues. Clear stakeholder roles and active care user involvement are crucial in ensuring that solutions align with user needs. Developing a robust digital framework for municipal clinics should focus on interconnected systems, continuous training, security, interoperability and positive care outcomes to support a successful transformation.

    A framework for the integrated digital transformation of municipal healthcare services in South Africa: The case of Gauteng · 2026 · DOI

  • The patient population in NHS hospitals that are managed with a tracheostomy has evolved significantly over the last 20 years. The majority are performed percutaneously by intensivists, in the Intensive Care Unit, on critically ill patients or those recovering from critical illness. Most tracheostomies are temporary. The vast majority of patients with ‘surgical’ and ‘non-surgical’ tracheostomies experience critical care at some stage of their journey. The multidisciplinary nature of tracheostomy care is a familiar working environment for our speciality, with tracheostomy care being perhaps one of the best examples truly multidisciplinary care. There is increasing evidence from national and international quality improvement programs that a multidisciplinary tracheostomy team that reviews and coordinates the management of tracheostomy patients can bring benefits for the quality and safety of care, including organisational efficiencies and significant cost savings. All patients with tracheostomies admitted to critical care units should expect safe care to be delivered by appropriately trained, equipped and supported staff. Patient-centred high-quality care also focusses on communication, vocalisation, mobilisation, information and a prompt return to oral intake. Improving the quality and safety of patients with tracheostomies and laryngectomies is a hospital-wide issue, and our speciality is well placed to lead and to contribute to the safe management of this vulnerable patient group. International quality improvement efforts should be supported. The key drivers of the Global Tracheostomy Collaborative (GTC) are examples of the hospital-wide changes that are required, which will involve and impact the ICU. The GTC key drivers are: 1. Multidisciplinary team-based care: Multidisciplinary tracheostomy team replacing siloed care, meeting face-to-face to coordinate and plan care, overcoming barriers to effective communication between providers. Such team-based care has been shown to reduce adverse events, length of stay, time to decannulation, increase speaking valve use and facilitate patient communication. 2. Standardisation of care: Standardised care protocols provide consistency in care, environment, equipment, and patient and provider expectations. Instituting such pathways and procedures promotes coordinated care, increases efficiency, and improves outcomes in airway emergencies. 3. Broad staff education: All patient encounters must involve healthcare staff who have been appropriately trained in tracheostomy care. Educational interventions have demonstrated marked improvement in objective knowledge and confidence with providing tracheostomy care, translating into safer patient care. 4. Patient and family involvement: Patients, their family and their carers are engaged in QI. Prioritising patient-centred care identifies key clinical outcomes, performance measures, and improvement areas that may otherwise not have been recognised. 5. Patient-level data: Hospitals track outcomes using a prospective database with detailed patient-level data captured each tracheostomy admission. Analytics allow the multidisciplinary team to benchmark over time and anonymously with peers within the Collaborative to assess the impact of initiatives. This is a standards document. Reference to external resources such as those provided by the ICS, FICM, RCoA, NTSP, GTC and individual hospitals (amongst others) are signposted throughout. Key evidence-based standards and recommendations are made at the end of each chapter. Key standards and recommendations are summarised in the table overleaf. Guidance For: Tracheostomy Care | 5 1. Executive summary, key standards and recommendations Table: Key standards in this document linked to key drivers to improve the quality and safety of tracheostomy care.

    Safety of Telemedicine Versus In-Person Care for Patients With Tracheal Devices: Propensity Score–Matched Cohort Study · 2026 · DOI

  • 18 19 Summarise key results with reference to study objectives Discuss limitations of the study, taking into account sources of potential bias or imprecision.

    Telemedicine Service Experience Questionnaire for Chinese Outpatients: Development and Validation Study · 2026 · DOI

  • The most commonly mentioned disadvantages of teleradiology among respondents include the possibility of errors in radiological procedures due to the lack of direct involvement of a radiologist in supervising the examination, the absence of a real-time monitoring system for the service, and the lack of standardization of hospital information systems.

    Assessment of the importance of teleradiology services in the opinion of electroradiologists in Poland · 2024 · DOI

  • s in audioinfrastructure, et al. through reducing unnecessary repeat testing, which is s video implement (2016) possible through the identification of early declines in connectivit redundant ________________________________________________ Saudi J. Med. Pub. Health Vol.

    Tele-ICU and Critical Care Patient Nursing Care through Remote Monitoring · 2024 · DOI

  • care (Ofoma et al., 2021). Tele-ICU addresses this by ensuring access to board-certified intensivists and critical care nurses in real time, and thereby providing high-quality care at resource-poor sites. In order to unlock the transformative potential of Tele-ICU, there are many strategic actions that must be taken to overcome the limitations of the current state and enhance the transformative nature of Tele-ICU on critical care A remarkable case study by RemoteICU (2021) delivery. First, it will be necessary to align measures of describes the challenges and impact of Tele-ICU in a rural, outcomes, including mortality, length of stay (LOS), and seven-bed ICU hospital. The hospital reported that before cost-effectiveness, to improve the temporal comparisons of Tele-ICU, its only option was to refer patients to larger Tele-ICU research studies that have concrete Tele-ICU centers, as it lacked an intensivist physically present in the utility and quality evidence (Lilly et al., 2014). Aligning hospital. After implementing the Tele-ICU service, the consistent and risk-adjusted measures will allow researchers hospital was able to manage the patients locally, as it referred ________________________________________________ Saudi J. Med. Pub. Health Vol.

    Tele-ICU and Critical Care Patient Nursing Care through Remote Monitoring · 2024 · DOI

  • Background: Tele-rehabilitation has been proposed as a post-hospitalisation rehabilitation pathway for Covid-19 survivors, however patients’ willingness and ability to engage with this online intervention remains unknown.

    Tele-rehabilitation for patients who have been hospitalised with Covid-19: a mixed-methods feasibility trial protocol · 2022 · DOI

  • COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups.

    COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use · 2021 · DOI

  • A substantial proportion rely on landline telephone service, use prepaid cellular phones with limited data plans, use mobile carriers with narrow data coverage, or have limited broadband access, a problem exacerbated by high Internet usage due to, for instance, virtual schooling requirements for their children.

    Telemedicine Services During COVID‐19: Considerations for Medically Underserved Populations · 2020 · DOI

  • For instance, the remote administration of achievement and intelligence tests is a relatively recent adaptation of telehealth, and despite recommendations for rapid adoption by some policymakers and publishing companies, caution and careful consideration of individual and contextual variables and the existing research literature, as well as measurement, cultural and linguistic, and legal and ethical issues, is warranted.

    Teleassessment with children and adolescents during the coronavirus (COVID-19) pandemic and beyond: Practice and policy implications. · 2020 · DOI

  • Little is known about the mechanisms that influence variation in ICU telemedicine effectiveness, leaving providers without guidance on how to best use this potentially transformative technology.

    Identifying Strategies for Effective Telemedicine Use in Intensive Care Units · 2017 · DOI

  • Information communication technologies ( ICT ) are an integral part of contemporary family life, though the existing research about its impact is scarce, less than definitive, and individually based, as well as failing to attend to cross‐cultural and cross‐national dimensions.

    Technology in families and the clinical encounter: results of a cross‐national survey · 2014 · DOI

  • Telecommunication offers a cost-saving alternative to face-to-face vocational rehabilitation (VR) service delivery, yet little is known about the current use.

    The Use of Telecommunication to Deliver Services to Rural and Urban Vocational Rehabilitation Clients · 2012 · DOI

  • FINDINGS: The utilization of TMH services varied widely between CBOCs, and the scope of services provided typically focused on delivery of medication management, with little provision of psychological services.

    VA Community Mental Health Service Providers’ Utilization of and Attitudes Toward Telemental Health Care: The Gatekeeper's Perspective · 2011 · DOI

  • CONTEXT: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined.

    VA Community Mental Health Service Providers’ Utilization of and Attitudes Toward Telemental Health Care: The Gatekeeper's Perspective · 2011 · DOI

  • CONTEXT AND PURPOSE: Rural and suburban populations remain underserved in terms of psychiatric services but have not been compared directly in terms of using telepsychiatry.

    Rural Versus Suburban Primary Care Needs, Utilization, and Satisfaction With Telepsychiatric Consultation · 2007 · DOI

  • RESULTS: More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility.

    Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients · 2002 · DOI

  • It seems worth reporting because it casts some light on dynamics and on technique; moreover, during this period of excessive demands upon analysts, any device which increases the analyst's potential should be explored for the possibility of helping him give service to more people.

    A Note on the Telephone as a Technical Aid · 1951 · DOI

  • In Egypt, there is limited evidence regarding the knowledge, attitudes, and perceptions of medical students and interns, representing a key segment of the future healthcare workforce.

    Awareness, attitudes, and practice intentions toward telemedicine among Egyptian medical students and interns · 2026 · DOI

  • These findings suggest that telehealth may support continuity of care without increasing acute care utilization, although its implications for chronic disease management quality remain uncertain.

    Association of primary care telehealth with preventable healthcare utilization and care continuity among patients with chronic conditions · 2026 · DOI

  • Further research is therefore needed on the long-term effect of telehealth interventions and their cost-effectiveness, considering the fact that currently available literature is insufficient and does not fully cover these topics.

    Impact of Telehealth on Chronic Disease Control: A Narrative Review · 2026 · DOI

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95 open questions have been extracted from the limitations and future-work passages of 1,567 Telemedicine and Telehealth Implementation papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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