Navigating tensions in telemedicine: A dynamic equilibrium approach to challenges and opportunities in digital health

The rapid expansion of telemedicine has redefined healthcare delivery, enabling greater access, cost-efficiency, and continuity of care. However, organizations adopting telemedicine face persistent tensions—between innovation and stability, access and quality, and user needs versus system demands. This study investigates how health systems can manage these competing pressures by applying the Dynamic Equilibrium approach to telemedicine implementation. Through a systematic literature review and bibliometric mapping of 28 selected studies (2018–2024), the research compares pre- and post-COVID developments to identify evolving priorities and challenges. The study synthesizes findings into an Opportunities–Challenges Matrix and proposes a conceptual framework outlining four interrelated dimensions: Learning, Belonging, Organizing , and Performing . These dimensions highlight the strategic trade-offs that digital health organizations must balance to ensure sustainable, inclusive service delivery. This research offers actionable insights for policymakers, healthcare managers, and digital health designers by clarifying the structural and strategic conditions required for telemedicine to succeed at scale. By navigating tensions rather than resolving them, health systems can foster innovation without compromising safety, system coherence, equity, or quality of care. • Synthesizes systematic insights from telemedicine adoption pre- and post-COVID-19. • Analyzes paradoxes between accessibility, innovation, and healthcare quality. • Highlights telemedicine’s role in enhancing inclusivity and operational efficiency. • Provides a conceptual framework for dynamic equilibrium in telemedicine services. • Offers strategic guidance for sustainable digital health transformation.