Background: Telemedicine is not significantly spreading globally and large variations in its availability and use exist internationally. While many factors already inhibit the dissemination of telemedicine, its complexly intertwined factors makes it more difficult to solve this problem. This study aimed to analyze and visualize relationships among factors inhibiting the dissemination of telemedicine. We applied the interpretive structural modeling (ISM) method and cross-impact matrix multiplication applied to classification (MICMAC) analysis. Materials and Methods:Factors inhibiting the dissemination of telemedicine in Japan were extracted by literature review and hearing from four medical informatics experts belonging to a university or hospital using KJ method.Results: Eighteen factors were extracted as those inhibiting the dissemination of telemedicine service in Japan; Initial and operation cost, Research

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