This study explores the challenges and potential solutions for implementing telemedicine in Iran from the perspective of health policymakers. Despite advancements in health technology and growing interest in telemedicine, its use remains limited in Iran. The research identifies eight main challenges: policy weaknesses, uncertainty in operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Four key solutions are proposed: national commitment to telemedicine development, establishment of a telemedicine roadmap, enhancement of e-health requirements and infrastructure, and preparation of the community to accept telemedicine as a viable healthcare option. The implementation of telemedicine in Iran faces significant challenges, some related to the national healthcare system and others stemming from policy-related institutions and organizations. Addressing these challenges requires extensive inter-organizational cooperation and strong leadership at the governance level. However, fully resolving these issues is a time-consuming process. The study emphasizes the need for a comprehensive approach, including education and information dissemination to policymakers, the establishment of a national digital health roadmap, and investments in communication infrastructure and information technology. Cultural and educational interventions are also crucial for promoting community acceptance of telemedicine. The findings highlight the importance of overcoming barriers such as lack of electronic health records, non-digital medical reports, and insufficient IT specialists and big data infrastructure. Additionally, economic challenges, including high costs and unclear reimbursement mechanisms, pose significant obstacles to the widespread adoption of telemedicine. The study concludes that a multifaceted approach involving collaboration, leadership, and investment is essential for the successful implementation of telemedicine in Iran.This study explores the challenges and potential solutions for implementing telemedicine in Iran from the perspective of health policymakers. Despite advancements in health technology and growing interest in telemedicine, its use remains limited in Iran. The research identifies eight main challenges: policy weaknesses, uncertainty in operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Four key solutions are proposed: national commitment to telemedicine development, establishment of a telemedicine roadmap, enhancement of e-health requirements and infrastructure, and preparation of the community to accept telemedicine as a viable healthcare option. The implementation of telemedicine in Iran faces significant challenges, some related to the national healthcare system and others stemming from policy-related institutions and organizations. Addressing these challenges requires extensive inter-organizational cooperation and strong leadership at the governance level. However, fully resolving these issues is a time-consuming process. The study emphasizes the need for a comprehensive approach, including education and information dissemination to policymakers, the establishment of a national digital health roadmap, and investments in communication infrastructure and information technology. Cultural and educational interventions are also crucial for promoting community acceptance of telemedicine. The findings highlight the importance of overcoming barriers such as lack of electronic health records, non-digital medical reports, and insufficient IT specialists and big data infrastructure. Additionally, economic challenges, including high costs and unclear reimbursement mechanisms, pose significant obstacles to the widespread adoption of telemedicine. The study concludes that a multifaceted approach involving collaboration, leadership, and investment is essential for the successful implementation of telemedicine in Iran.