Digital Health · Published 2026-02-01 · DOI 10.1177/20552076261467833
Background Telemedicine is becoming embedded within hybrid care models integrating remote and in-person services across longitudinal pathways. Implementation challenges are often driven by sociotechnical misalignment and governance fragmentation rather than by technological limitations alone. However, few studies have examined how vulnerabilities emerge and accumulate across sequential stages of telemedicine delivery. Objective This study aimed to not only examine process-level vulnerabilities across a hybrid telemedicine care pathway but also develop a pathway-oriented sociotechnical perspective on telemedicine implementation. Methods This qualitative study involved 13 participants in South Korea, including 5 physicians (individual in-depth interviews) and 8 patients (focus groups, including individuals with disabilities) with telemedicine experience. Data were analyzed using reflexive thematic analysis informed by a sociotechnical implementation perspective aligned with the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. Sequential pathway stages—appointment, identity verification, data submission, teleconsultation, prescription, and medication access and follow-up—were mapped to identify cross-stage vulnerabilities. Results Vulnerabilities were categorized into four domains: responsibility ambiguity, workflow discontinuity, technological constraint, and governance fragmentation, being most pronounced at stage interfaces, where inconsistent authentication, fragmented prescribing workflows, and incomplete information transfer undermined careful continuity and safety. Accessibility challenges functioned as cross-cutting system properties rather than as individual-level limitations. Importantly, vulnerabilities accumulated across stages, reinforcing uncertainty in hybrid care coordination. Conclusion Telemedicine implementation should be conceptualized as a longitudinal sociotechnical pathway requiring alignment across governance, workflow, platform design, and regulatory structures. A pathway-oriented perspective could support system-level interventions to improve safety, equity, and sustainability in hybrid digital health systems.
Abstract from DOAJ. Public domain (CC0 1.0).
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