From what I can tell, the two biggest factors holding back telehealth adoption include FUD and fear of competition. In the case of FUD, some folk point to the very few bad apples that push real pills to addicts or sell fake pills to addicts. In both cases, those are crimes and are happening today, with or without telemedicine. They also occur in the world of bricks and mortars medical practices, unfortunately. You'd think some smart healthcare professionals, in tandem with some smart lawyers, could figure out a way to create sensible rules -- ie, preventing US telemedicine providers to see US patients from outside the country -- to ensure practitioners and patients would be under US law enforcement's sphere of influence if wrongdoing occurs. As to competition, from the handful of doctors I've spoken to who work for telehealthcare organizations, they like this alternative career opportunity. Facing additional competition is tough; it really is. But there is room for traditional providers to work with telehealth if they don't want to work against it.