This study investigates the challenges and potential solutions for implementing telemedicine in Iran from the perspective of health policymakers. Conducted in 2022, the qualitative study involved 19 policymakers through in-depth and semi-structured interviews. The main challenges identified include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Four key solutions were proposed: national commitment to telemedicine development, establishment of a telemedicine roadmap, enhancement of e-health requirements and infrastructure, and community preparation to accept telemedicine. The study highlights the need for inter-organizational cooperation and strong leadership to overcome these challenges, emphasizing that a pragmatic approach is essential for accelerating telemedicine implementation in Iran.This study investigates the challenges and potential solutions for implementing telemedicine in Iran from the perspective of health policymakers. Conducted in 2022, the qualitative study involved 19 policymakers through in-depth and semi-structured interviews. The main challenges identified include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Four key solutions were proposed: national commitment to telemedicine development, establishment of a telemedicine roadmap, enhancement of e-health requirements and infrastructure, and community preparation to accept telemedicine. The study highlights the need for inter-organizational cooperation and strong leadership to overcome these challenges, emphasizing that a pragmatic approach is essential for accelerating telemedicine implementation in Iran.