| Integration and interoperability | Difficult for mHealth apps to be integratable in current health IT systems and their lack of connectivity with other technology solutions | Consumers not willing to pay | Consumers expect all applications to be free or low-priced, just as in the different app-markets |
| Business case | High risk investment needed in unsure market | Conservative nature | Healthcare is traditionally conservative due to the importance of personal contact and risk averse behavior |
| Conservative culture | Existence of a conservative culture among healthcare professionals for new technologies | Unfamiliarity with healthcare | Developers are mostly new in the healthcare market and possess insufficient health knowledge |
| Visionless development | Current developments of mHealth applications miss focus and vision for added value | No involvement of end users | Physicians and patients are insufficiently involved during the development phase |
| Not adapted to physicians | Difficult for physician to adapt new technologies in their current work-environment | High expectations for privacy | The general population has high standards for privacy preservation |
| Privacy and security | High expectations for proper security with privacy sensitive information | Absence of health insurers | Health insurers are not taking the lead where they should, due to the non leading role of the government |
| Lack of governance | Not enough central control and steering from the government | Open standards and APIs | Open standards and APIs make integration easy and possible on a high systemic level |
| Lack of evidence | Insufficient evidence of clinical outcomes, effectiveness and efficiency | Strategic funding programs by health insurers | Health insurers should strategically fund initiatives that are integratable from start and deliver value on the long-term |
| Competing payment mechanism | Current pay-per-performance is outdated and not compatible with mHealth’s prevention focus | Higher value for funding parties | New initiatives should better match the needs of funding parties and collaborate with them on an early basis |
| Legislation | National and international legislation about medical devices is unclear, to strict and outdated | More realistic approach | Realistic approach and more focus on the end-results, such as efficiency and digitalization |
| Lack of access for patients | Use of mHealth applications asks for a high degree of (technological) knowledge and is to costly | Collaborations with end users | Better collaborations with end users and stakeholders, such as doctors and patients |
| Technological obstacles | Current solutions are too complex. Furthermore connectivity and battery lacks performance | Good information and review opportunities | The government should provide guidelines and review opportunities for new initiatives |
| No realistic expectations | Too high and unrealistic expectations of integration and interoperability of all technological devices | New performance policy | New policy about performance funding for healthcare professionals, where health results should be the measuring tip |
| Closed power of suppliers | Limited amount of health IT suppliers with a closed power system | Better market phase | Waiting for a better market phase which is more sophisticated and developed |