Adopting Health Apps, What’s Hindering Doctors and Patients?


There are high expectations for Mobile Health to transform health into a sustainable and prevention-based system. Unfortunately it has not reached its scale of adoption many had hoped for, due to the existence of adoption barriers. More insight into these barriers fosters adoption of mHealth and the innovation it can bring to worldwide healthcare. This study investigates the main barriers in the adoption of mHealth, their underlying causes and their breakthrough possibilities. All the data are gathered from an international and multi-stakeholder point of view. First of all we tried to identify the main barriers by doing an international literature study. Second of all we asked Dutch mHealth Key Opinion Leaders (KOLs) to rank the barriers to importance. These KOLs were from different stakeholder groups; policy-makers, users and developers. At last we asked the KOLs in interviews for underlying causes and breakthrough opportunities of the barriers. Eventually twelve main adoption barriers emerged. According to literature and to the KOLs the most important barriers are “Integration and interoperability” and “Business case”. An underlying cause for the barrier “Integration and interoperability” might be the active closed power system of technology suppliers, which exists in the Netherlands. Furthermore there seems to be a difference in the importance of the barriers “Privacy and security” and “Conservative culture” when perceptions of Dutch KOLS and international literature are compared. Within the stakeholders-groups, the KOLs think differently about the importance of the barriers “Visionless development” and “Competing payment mechanism”. The Dutch healthcare insurers could take a more leading role in the fragmented landscape of mHealth in the Netherlands, by strategically funding new initiatives that use open standards and deliver better value for end-users. Other chances might lie in the international cooperation between countries to overcome certain barriers.

Share and Cite:

Dehzad, F. , Hilhorst, C. , de Bie, C. and Claassen, E. (2014) Adopting Health Apps, What’s Hindering Doctors and Patients?. Health, 6, 2204-2217. doi: 10.4236/health.2014.616256.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Advanced Institute of Management Research (2012) Opening up Healthcare Innovation.
[2] GSMA (2012) Touching Lives through Mobile Health: Assessment of the Global Market Opportunity.
[3] Omachonu, V.K. and Einspruch, N.G. (2010) Innovation in Healthcare Delivery Systems: A Conceptual Framework. The Public Sector Innovation Journal, 15, Article 2.
[4] Buntin, M.B., Burke, M.F., Hoaglin, M.C. and Blumenthal, D. (2011) The Benifits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results. Health Affairs, 30, 464-471.
[5] Eysenbach, G. and Diepgen, T.L. (2001) The Role of e-Health and Consumer Health Informatics for Evidence-Based Patient Choice in the 21st Century. Clinics in Dermatology, 19, 11-17.
[6] WHO (2011) mHealth: New Horizons for Health through Mobile Technologies.
[7] Labrique, A., Vasudevan, L., Chang, L.W. and Mehl, G. (2013) H_pe for mHealth: More “y” or “o” on the Horizon? International Journal of Medical Informatics, 82, 467-469.
[8] UN Foundation, Vodafone Foundation (2009) mHealth for Development.
[9] Akter, S., D’Ambra, J. and Ray, P. (2013) Development and Validation of an Instrument to Measure User Perceived Service Quality of mHealth. Information & Management, 50, 181-195.
[10] Steinhubl, S.R., Muse, E.D. and Topol, E.J. (2013) Can Mobile Health Technologies Transform Health Care? JAMA, 310, 2395-2396.
[11] Kearney, A.T. (2012) GSMA Improving the Evidence for Mobile Health.
[12] Wu, I.L., Li, J.Y. and Fu, C.Y. (2011) The Adoption of Mobile Healthcare by Hospital’s Professionals: An Integrative Perspective. Decision Support Systems, 51, 587-596.
[13] Vishwanath, A. and Scamurra, S.D. (2007) Barriers to the Adoption of Electronic Health Records: Using Concept Mapping to Develop a Comprehensive Empirical Model. Health Informatics Journal, 13, 119-134.
[14] Li, J., Talaei-Khoei, A., Seale, H., Ray, P. and Macintyre, C.R. (2013) Health Care Provider Adoption of eHealth: Systematic Literature Review. Interactive Journal of Medical Research, 2, e7.
[15] Norris, A.C., Stockdale, R.S. and Sharma, S. (2009) A Strategic Approach to m-Health. Health Informatics Journal, 15, 244-253.
[16] The Economist Intelligence Unit (2012) Emerging mHealth: Paths for Growth. London.
[17] Tomlinson, M., Rotheram-Borus, M.J., Swartz, L. and Tsai, A.C. (2013) Scaling up mHealth: Where Is the Evidence? PLoS Medicine, 10, e1001382.
[18] Mirza, F., Norris, T. and Stockdale, R. (2008) Mobile Technologies and the Holistic Management of Chronic Diseases. Health Informatics Journal, 14, 309-321.
[19] Whittaker, R. (2012) Issues in mHealth: Findings from Key Informant Interviews. Journal of Medical Internet Research, 14, e129.
[20] Gruber, H., Wolf, B. and Reiher, M. (2009) Innovation Barriers for Telemonitoring. World Congress on Medical Physics and Biomedical Engineering, Munich, 7-12 September 2009, 48-50.
[21] Weenen, T.C., Pronker, E.S., Commandeur, H.R. and Claassen, E. (2013) Barriers to Innovation in the Medical Nutrition Industry: A Quantitative Key Opinion Leader Analysis. PharmaNutrition, 1, 79-85.
[22] Ruder Finn (2013) mHealth Report. New York.
[23] PwC (2012) Touching Lives through Mobile Health: Assessment of the Global Market Opportunity. London.
[24] Yu, P., Wu, M.X., Yu, H. and Xiao, G.Q. (2006) The Challenges for the Adoption of M-Health. 2006 IEEE International Conference on Service Operations and Logistics and Informatics, Shanghai, 21-23 June 2006, 181-186.
[25] PwC (2013) Socio-Economic Impact of mHealth: An Assessment Report for the European Union. London.
[26] Liu, C., Zhu, Q., Holroyd, K.A. and Seng, E.K. (2011) Status and Trends of Mobile-Health Applications for iOS Devices: A Developer’s Perspective. Journal of Systems and Software, 84, 2022-2033.
[27] Free, C., Phillips, G., Watson, L., Galli, L., Felix, L., et al. (2013) The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis. PLoS Medicine, 10, e1001363.
[28] Research2Guidance (2013) MOBILE HEALTH MARKET REPORT 2013-2017: The Commercialization of mhealth Applications. Berlin.
[29] Alpay, L.L., Henkemans, O.B., Otten, W., Rovekamp, T.A. and Dumay, A.C. (2010) E-Health Applications and Services for Patient Empowerment: Directions for Best Practices in The Netherlands. Telemedicine Journal and e-Health, 16, 787-791.
[30] Schafer, W., Kroneman, M., Boerma, W., van den Berg, M., Westert, G., Devillé, W. and van Ginneken, E. (2010) The Netherlands: Health System Review. Health Systems in Transition, 12, 1-229.
[31] Van Weel, C., Schers, H. and Timmermans, A. (2012) Health Care in The Netherlands. Journal of the American Board of Family Medicine, 25, S12-S17.
[32] JRC-IPTS (2012) Strategic Intelligence Monitor on Personal Health Systems Phase 2 Country Study. Luxembourg.
[33] Jha, A.K., Doolan, D., Grandt, D., Scott, T. and Bates, D.W. (2008) The Use of Health Information Technology in Seven Nations. International Journal of Medical Informatics, 77, 848-854.
[34] VvAA (2013) Wat geld(t) in de zorg? Mobile Health.
[35] Herzlinger, R. (2006) Why Innovation in Health Care Is So Hard. Harvard Business Review.
[36] Hadjimanolis, A. (1999) Barriers to Innovation for SMEs in a Small Less Developed Country (Cyprus). Technovation, 19, 561-570.
[37] Pronker, E., Weenen, T., Commandeur, H., Claassen, E. and Osterhaus, A. (2013) Exploratory Sector Level Analysis of Key Opinion Leaders on Novel Adjuvanted-Vaccine Development. In: Innovation Paradox in Vaccine Target Selection, Erasmus Research Institute of Management, Rotterdam, 55-74.
[38] Vodafone (2011) Evaluating mHealth Adoption Barriers: Human Behaviour.
[39] GSMA (2012) mHealth US End-User Research: Beliefs, Barriers, Success Factors and Recommendations. London.
[40] Clark, J. and McGee-Lennon, M. (2011) A Stakeholder-Centred Exploration of the Current Barriers to the Uptake of Home Care Technology in the UK. Journal of Assistive Technologies, 5, 12-25.
[41] Shieh, Y.Y., Wang, M.D., Tsai, F.Y. and Lin, C.C. (2007) Mobile Healthcare: Opportunities and Challenges. 6th International Conference on the Management of Mobile Business, Toronto, 9-11 July 2007, 50-58.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.