Barriers to and Facilitators of Telemedicine in Rural Healthcare in Japan: A Qualitative Analysis

Background Telemedicine can be used to improve healthcare access. However, it is used less frequently in Japan, particularly in the rural areas. Rural healthcare systems in Japan are unique in that medical services are delivered through a collaboration between core hospitals and rural clinics. Rural clinics provide primary care, whereas core hospitals are expected to provide support through telemedicine-based inter-professional communication. This study qualitatively investigated the major barriers and facilitators of telemedicine adoption in rural settings, particularly from the perspective of core hospitals that support rural clinics. Methods One-on-one semi-structured interviews were conducted at nine core hospitals that used or were ready to use telemedicine systems. The interviews investigated barriers to and facilitators of telemedicine adoption. Results Three barriers and 10 facilitators were identified regarding the telemedicine adoption. These barriers included: 1) budgetary, 2) human resources, and 3) operational issues. Facilitators were conceptually grouped into three domains: 1) institutional and policy-level support (incentives, establishment of operational rules and guidelines, consultation services by local governments, use of consultants, and preparation of trouble response teams), 2) professional and workforce development (human resource education), and 3) community and cultural acceptance (user-friendly systems, collaboration across communities, overcoming field-level apprehension, and resident comprehension). Conclusions While barriers largely reflected structural constraints, facilitators were identified across the institutional, professional, and community levels. Among these, the development of user-friendly systems emerged as a potentially important facilitator in the context of telemedicine adoption in rural Japan. These findings may provide useful insights for promoting telemedicine adoption in core hospitals supporting rural healthcare in Japan.