title: [Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts].
abstract: OBJECTIVE
  Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts.
  
  
  METHODS
  We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations.
  
  
  RESULTS
  The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability.
  
  
  CONCLUSIONS
  In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer.
authors: Programa de Ciencias de la Salud, Universitat Oberta de Catalunya, Barcelona, España. froig@uoc.edu
authors: Francesc
authors: F
authors: Roig
authors: Francesc
authors: F
authors: Saigí
mesh_terms: D001291:Attitude of Health Personnel; D003284:Contract Services / Q000191:economics / Q000458:organization & administration*; D032982:Contracts; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D006282:Health Personnel / Q000191:economics*; D006801:Humans; D008962:Models, Theoretical; D036301:Qualitative Research; D012922:Social Change; D013030:Spain; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*