Background: Telemedicine has emerged as a revolutionary method for delivering healthcare, especially in response to the growing need for accessible and efficient medical services. This study examines the causal relationships between several factors contributing to the development of telemedicine and ranks them to inform effective decision-making. Materials and Methods: Initially, 26 key factors influencing the development of telemedicine were identified through a scoping review, which were then analyzed based on the STEEPLE framework. Subsequently, the DEMATEL method was employed to assess the interrelationships among these factors, with a questionnaire presented to 92 experts. The degree of impact of each factor on others was incorporated into an impact matrix. Once the matrix was normalized and the total relation matrix calculated, we examined the causal relationships, intensity of impact and dependence, and the significance of each factor. Results: The DEMATEL-based findings revealed the “environmental issues and associated health impacts” as the primary driver in the system, exerting the highest impact on other factors. “Workforce-related factors” emerged as the most dependent factor in the system. Moreover, the (D + R) value indicated that the “formulation of policies and business standards, funding, and workforce” constituted the most significant factor with the highest level of interaction with other system variables in advancing telemedicine. Conclusion: Given the complexity of healthcare systems, administrators are unable to consider every possible factor. Instead, they should focus their efforts and resources on the most influential and problematic elements to develop a sustainable and efficient health system.
Salehi et al. (2026) studied this question.