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Despite the known benefits of telehealth, many barriers exist to its adoption by healthcare organizations and systems. Some of these barriers relate to a perceived lack of resources such as financial cost to set up a telehealth program and the technology required for remote clinic visits or transfer of diagnostic data with an unclear return on investment (ROI). Indeed, telehealth outcomes are, by nature, difficult to measure and few traditional cost‐benefit analyses have been done [12]. Some of the reported barriers about the perceived burden of telehealth are related to human factors, such as the extra work required by providers who may lack familiarity with telehealth and its related technology and thus become resistant, or privacy concerns about patient health information being shared remotely. A recent telemedicine intervention for shared survivorship care for childhood cancer survivors between oncology and primary care reported the service was beneficial overall to providers and patients, but the technology glitches and extra time needed were frustrating for all parties [32]. Some of the barriers are regulatory or legal in nature with concerns about credentialing and licensing across state lines and potential liability for care delivered via telehealth. Some of the barriers are related to unclear evidence for outcomes and a lack of willingness to invest in programs that do not have easily measured metrics to share with the institutions’ decision makers [15,26]. Reimbursement of providers delivering care via telemedicine is critical and remains one of the major obstacles for implementation of a successful telehealth program [13].

One important way to overcome barriers for adopting a telemedicine program is to invest in the development of outcome measures for telehealth. Providing the evidence that telemedicine significantly improves patient outcomes is key to convince organizational decision makers to develop a telemedicine program, and the argument would be even stronger if improved patient outcomes are seen without taxing the financial resources of the institution. Outcomes evidence that supports telehealth can also lead to better reimbursement, increased willingness of providers to engage in this healthcare delivery model and patient acceptance of telemedicine care. The National Quality Forum has developed a framework to support measure development in telehealth and can be used as a model for telehealth outcomes research. The framework includes the following domains: access to care (for patient/family/caregiver, care team, to information), financial impact/cost (to patient/family/caregiver, care team, health system/payor, society), experience (patient/family/caregiver, care team, community), and effectiveness (system, clinical, operation, technical). By using a standardized framework for outcomes measurement, telehealth outcomes will make a case for further program development [17].