developing countries are using telemedicine to link health centers , tertiary centers , and referral hospitals . several e - health applications , such as telemedicine , can be found with different degrees of success in majority of developing countries [ 1 , 2 ] . according to , the following two factors explain the wide use of telemedicine : the lack of alternatives such as building hospitals in each village which is costly and ( 2 ) the apparent geographical superiority of telemedicine over traditional medicine . despite high expectations from the technology , configuring its use into a certain routine the framework of adopting telemedicine in iraq was categorized into four characteristics , namely , technological , organizational , environmental , and individual . thus , the influencing factors are enablers in the decision - making and e - participation of hospitals . this study illustrates a suitable design of the questionnaire on willingness to adopt telemedicine of telemedicine in iraq to evaluate the framework . these benefits can affect not only the health providers and the patients , but also the entire healthcare organization . for example , a study on physicians and health managers in the quebec health region in canada by   found that the benefits and usefulness of the telemedicine system were seen on three levels : ( 1 ) clinical / patient , ( 2 ) professional / educational , and ( 3 ) organizational . first , studies regarding telemedicine in iraq are limited , with few studies conducted by the ministry of health of iraq . second , the physicians ' level of understanding of telemedicine is limited because telemedicine is a new technology in iraq [ 5 , 7 ] . third , only a handful of physicians practice electronic consultation ( e - consultation ) . fourth , physicians have limited grasp and knowledge of data warehouse because it is viewed and considered as a new tool in telemedicine . fifth , the number of respondents was 35 only . finally , the unstable political climate and strife in iraq added challenges to the scope and limitations of this study . the technology - organization - environment ( toe ) framework , which was developed by , is chosen and applied as the framework of this study . [ 1 , 2 ] , these studies have demonstrated consistent support for toe 's ability to provide a comprehensive perspective on innovation adoption , while facilitating the flexibility to identify and categorize unique factors that may emerge in particular situations . moreover , the main reason for selecting this framework is that this approach has the potential to address issues of this study . on the subject of appropriate framework selection , advocates a framework that has been adapted and adopted and requires further development and fine - tuning in its application for contextual matching . this study adapted the toe framework to improve its suitability in the field of telemedicine . in addition , social exchange theory , diffusion of innovation theory , toe adoption framework , and previous studies are employed to investigate the factors that influence telemedicine in iraq . these theories have been applied in electronic information sharing studies [ 11 , 12 ] . thus , factors such as top management support of upper - level leadership are employed . the focus of this theory is to help organizations and individuals in deciding whether to adopt or reject a new innovation and to estimate the duration of acceptance and use of a new technology . in reality , the theory has been used to clarify and evaluate a wide range of it adoption , such as that of the internet , database machine , software engineering techniques , and it in general . the remaining factors have been adopted from researches done in middle eastern countries such as kuwait and jordan . the influencing factors of the current research are privacy , culture , attitude to telemedicine , benefit , connectivity , it capability , compatibility , data warehouse concept , technical support , top management support , cost , approach , and upper - level leadership . the factors that can promote engagement in the willingness to accept telemedicine have been identified . the pilot study is performed to evaluate the questionnaire items and to determine the appropriate questions for the survey . the survey method is employed in this study because surveys are prevalently used to begin reports and it is a suitable method for examining factors and hypotheses . paper   shows that the questionnaire design relies on three criteria , namely , the manner by which the questions are written , planning for the classification of variables , and the appearance of the questionnaire . suggestions and advice from colleagues and supervisors are considered in improving the design of the questionnaire , as well as in developing the questionnaire . the questionnaire is written in english and then translated into arabic , which is the official language in iraq . questionnaires were distributed among physicians who are working in baghdad medical city . among the 35 questionnaires collected , only 5 were not correctly answered . queries on the method of how physicians conduct electronic consultation in inputting patient information were conducted in this study . five methods were mentioned in the questionnaire , but the participants were provided an option to add another method that they have used . however , no other method of information sharing was added by the participants . figures 2 , 3 , 4 , and 5 illustrate the percentages of the most used method of electronic consultation . the data collected reveal that e - mail is the most used method in electronic consultation . the results from the two pilot studies reveal that the most used means of electronic consultation between physicians and patients are phone , e - mail , and website . the electronic information sharing practice in the iraqi healthcare sector was measured in terms of the percentage of electronic consultation used and the time information consultation was initiated . thus , based on the findings , the participants of the pilot studies illustrated the percentage of electronic consultation used . most of the participants revealed that the percentage of consultation is 63.3% from 1% to 20% of their work . most of the participants mentioned that electronic consultation was initiated between 1 year and 3 years ago . the most commonly used test in reliability measurement of any pilot study questionnaire is cronbach 's alpha [ 18 , 36 ] . according to , cronbach 's alpha test possesses values within the range of 0 to 1 ; a higher level of range indicates greater value of reliability . values of 0.9 and above are excellent , 0.8 and above are good , 0.7 and above are acceptable , 0.6 and above are questionable , and less than 0.6 are poor [ 37 , 38 ] . the data collected from the two pilot studies have been analyzed using statistical package for the social sciences 20 to identify the values of each factor in cronbach 's alpha . based on the pilot study , no change should be made in the items of the pilot study . these items were rewritten to create a clear and easy - to - understand questionnaire . thus , all factors have values of more than 0.7 , which are acceptable . this study was proposed to examine the influencing factors in the willingness to adopt and practice telemedicine in iraq . this study was prompted by a real need to examine the requirements , challenges , and gaps in adopting this new technology . a set of items of questionnaires was designed based on previous studies on the adoption of telemedicine in the middle eastern countries , such as kuwait , saudi arabia , jordan , and syria . the pilot studies were conducted to examine each influencing factor in the hypotheses and to test the reliability of the questionnaire . cronbach 's alpha test in the pilot study reveals that the factors have values more than 0.7 , which are acceptable . a research paper will follow this study to illustrate the results of the data analysis of the survey . the results of the tests are expected to contribute to furthering the understanding and grasp of electronic information sharing in the healthcare sector . in addition , research of willingness to adopt telemedicine needs to be examined in rural area since it has different factors to measure .
the iraqi healthcare services are struggling to regain their lost momentum . 
 many physicians and nurses left iraq because of the current situation in the country . despite plans of calling back the skilled health workforce , 
 they are still worried by the disadvantages of their return . 
 hence , technology plays a central role in taking advantage of their profession through the use of telemedicine . studying the factors that affect the implementation of telemedicine is necessary . 
 telemedicine covers network services , policy makers , and patient understanding . 
 a framework that includes the influencing factors in adopting telemedicine in iraq was developed in this study . 
 a questionnaire was distributed among physicians in baghdad medical city to examine the hypothesis on each factor . 
 the statistical package for the social sciences was utilized to verify the reliability of the questionnaire and cronbach 's alpha test shows that the factors have values more than 0.7 , which are standard .