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The importance of champion leaders including tech-savvy leaders to digital government has been highlighted in the literature. Meanwhile, what was in the authors’ interest to explore was the role of business-savvy leaders or non-governmental digital champions as units of analysis, those who mobilized people's interest in digitalization and bypassed governmental barriers through this popular mobilization. They could be considered policy entrepreneurs for understanding policy change in the digitalization of the health sector. This study sought to shed light on the barriers and drivers of digital health in Iran.

The researchers conducted interviews with actors of digital health businesses in Iran, including the Health Information Technology Center affiliated to the Ministry of Health and Medical Education (MOHME) administrative body and authorities, private companies active in digital health and health service providers. The purposive sampling method was applied, and 15 experts with relevant and valuable experiences as well as maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were also used to assure the quality of the results. The data were analyzed based on directed content analysis using the MAXQDA10 software.

It was found out how popular diffusion was effective to overcome barriers to health digitalization. Access to the internet and diffusion of information technology helped the net-enabled businesses to connect directly to people and provide services to them. Diffusion of these services forced the public sector to adjust itself, and thus MOHME banned digital consultation services because of the so-called “insecure and unknown physicians”, following the increased popularity of digital services diffusion, but they were not able to resist popular diffusion of new technology. Hence, it was allowed to work. The main barriers to telemedicine spreading in Iran have been divided into five main categories including government incapacity for digital health governance, conflict of interest, professional obligations for information transparency, protection of patients' rights and data security and privacy.

As a game changer in digital health governance in Iran, popular diffusion will determine the future of digital health. To the best of the authors’ knowledge, this study is among the first ones to explore digital health governance in relation to the private digital health business in Iran with a public policy approach.