Trends in telemedicine consultations by the ministry of health in Saudi Arabia from 2019 to 2023: Leadership implications from a retrospective study

Abstract

Background

There is growing interest in telemedicine services globally. Saudi Arabia has introduced several telemedicine initiatives to relieve pressure on in-person clinical services and improve healthcare quality and accessibility.

Objectives

To analyze trends in telemedicine consultation services by the Ministry of Health in Saudi Arabia between 2019 and 2023.

Methods

A retrospective comparative analysis was conducted using an open-access secondary dataset from the Ministry of Health via the Saudi Open Data Platform. The trend in telemedicine service use over time was examined using descriptive and trend analyses.

Results

Telemedicine consultations increased sharply from around 3.1 million in 2019 to 8.8 million in 2021, then declined to 4.3 million in 2023. Most telemedicine consultations were through the 937 service (86.1%), followed by the Sehhaty app (11.53%). Cumulative growth in telemedicine consultations from 2019 to 2023 remained positive for the 937 service (29.0%), Sehhaty app (34.7%), and e-prescription (Wasfaty) system (1051.8%), but declined for the Twitter/X platform (−40.0%). Despite high user satisfaction with the 937 service over the study period (96.4%–98.1%), there was a marginal but persistent decline in user satisfaction with the Sehhaty app (91.8% to 78.0%).

Conclusion

In Saudi Arabia, telemedicine consultations have increased since 2019, except for those delivered via the X platform. As the most frequently used channel, the 937 service requires specific attention. Although the Sehhaty app and the Wasfaty system have demonstrated considerable potential, further development and simplification are needed. Health service planners and policymakers should prioritize user satisfaction to promote the adoption of telemedicine services.

Keywords

937 service digital health e-health healthcare leadership health information management Saudi Arabia sehhaty app telehealth telemedicine wasfaty system

Introduction

Telemedicine is “the use of telecommunications technology to deliver healthcare services.”¹ Telemedicine services have become an essential component of contemporary healthcare systems, facilitating patients’ access to required services and relieving pressure on clinical-based healthcare.^2,3

In Saudi Arabia, the Ministry of Health (MOH) provides telemedicine consultation services via the 937 service, the Sehhaty app, the Wasfaty prescription system, and the social media platform X (formerly Twitter). These telemedicine channels represent different modes of virtual healthcare delivery that different user groups likely use for different purposes. The 937 service is a 24-hour telemedicine call center operated by the MOH, offering medical and treatment consultations through trained physicians and healthcare professionals. It also handles notifications and complaints about the quality of healthcare services.⁴ The Sehhaty app provides digital health functions, including accessing telemedicine consultations, booking appointments at health facilities, requesting repeat prescriptions, monitoring health records, and performing other related activities.⁵ The Wasfaty system provides digital services that link hospitals and primary healthcare centers to community pharmacies, allowing patients to consult with healthcare professionals and manage prescribed medicines, devices, and medical supplies free of charge.⁶ The MOH also utilized the X platform to provide health education and telemedicine consultations.⁷

These digital health services should be viewed within the broader context of the Saudi Health Sector Transformation Program under Saudi Vision 2030, a national initiative dedicated to developing the Saudi healthcare sector, including improving e-health subprograms and integrating digital health into the new national healthcare model.^8,9 For example, the MOH launched Seha Virtual Hospital in 2020, which is the largest virtual hospital worldwide and the first of its kind in the Middle East, supporting telemedicine services in about 170 hospitals nationwide and offering over 100 specialized and sub-specialized digital services.^10,11

Healthcare systems worldwide have shown increasing interest in developing telemedicine services to meet growing demand for healthcare. However, the sustainable integration of telemedicine into routine healthcare services still faces critical challenges,^3,12 including administrative and financial issues,^13,14 technological adoption difficulties,^14,15 a shortage of trained personnel to support telemedicine,¹³ and societal attitudes toward healthcare services.^14,16

A recent study in the United States examined the trend in telemedicine adoption across hospitals from 2017 to 2022.¹⁷ It found that telemedicine use expanded by 75% over this period, growing from 111.4 million patient encounters in 2020 to nearly 194.4 million in 2021. In addition, hospital adoption of telemedicine services increased from 46% in 2017 to 72% in 2021, a trend driven primarily by large, nonprofit, and teaching hospitals. Notably, no significant urban–rural differences were observed. Nonetheless, despite rapid growth, telemedicine implementation remains uneven, with information blocking and cost continuing to hinder its full integration.

A systematic review of telemedicine services in sub-Saharan Africa found that, despite their benefits, their adoption remains limited, primarily due to weak or absent policies, low political commitment, high costs, inadequate funding, insufficient technology infrastructure, negative attitudes among patients and healthcare workers, and cultural challenges.¹⁴

Most previous studies on telemedicine services in Saudi Arabia have focused on user opinions, user satisfaction, public awareness, or barriers related to virtual care and digital health services. For instance, AlShareef and AlWabel¹⁸ conducted a nationwide cross-sectional survey of user opinions on telemedicine consultations in Saudi Arabia. Among their respondents, over 90% preferred virtual consultations to in-person visits, reporting efficiency, reliability, and convenience as key benefits. Although some respondents reported technical challenges, 97.4% were satisfied with their remote consultation experiences. Notably, respondents who expressed less satisfaction with virtual consultations preferred face-to-face consultations.

In addition, Al-Garni et al.¹⁹ explored patients’ experiences and satisfaction with virtual healthcare services received during the coronavirus disease 2019 (COVID-19) pandemic. Most participants (83%) were satisfied with these services regarding physician performance, service quality, and respect for privacy. Notably, no associations between satisfaction level and patient characteristics or service type received were observed.

Moreover, Al-Sulimani and Bouaguel²⁰ examined the attitudes of patients with diabetes mellitus in Saudi Arabia toward digital health services, including telemedicine. They found that patients’ attitudes toward these services were strongly associated with their perceived usefulness and ease of use. They emphasized the importance of increasing public awareness of digital health services and of addressing concerns about privacy and trust.

Altogether, previous studies from Saudi Arabia do not provide a consolidated picture of how telemedicine service utilization has changed over time across multiple virtual channels. Therefore, this study aimed to fill this gap by analyzing usage trends in telemedicine consultations from 2019 to 2023 and describing available data on user satisfaction to support informed decision-making.

Methods

Design

This retrospective comparative study examined secondary data on telemedicine consultations provided by the MOH in Saudi Arabia.

Data source and collection

The data were collected, organized, and released by the MOH through the Saudi Open Data Platform, which provides open access to a wide range of government datasets.²¹ It is part of a governmental initiative to enhance transparency by sharing high-value open data in free and reusable formats.

The dataset used in this study contains yearly numerical records on telemedicine consultations organized via the 937 service, the Sehhaty app, the Wasfaty system, and the X platform.²² It also contains data on annual satisfaction with both the 937 service and the Sehhaty app. User satisfaction is measured through post-service surveys via SMS with a link or direct phone calls from the MOH.²³ The data are open and publicly accessible, and can be used by third parties without prior individual approval, provided that they comply with the terms of the Open Data License.^24,25

Ethical considerations

This study used annual data on telemedicine services obtained over five years and did not involve identifiable information. It complied with the Saudi Open Data License policy for ethical and appropriate use of the data.^24,25 This study also received approval from the Committee for Research Ethics at Jazan University (reference no. REC-47/09/1806).

Data analysis

The data were analyzed using SPSS Statistics (version 30.0; IBM Corp., Armonk, NY, USA). Patterns in telemedicine consultations over time were examined through descriptive and trend analyses, supported by data visualizations. The data are reported as frequencies and percentages. User satisfaction with telemedicine consultations was visualized using clustered column charts.

Results

Overall volume of telemedicine consultations

The MOH delivered more than 31 million telemedicine consultations between 2019 and 2023 (Table 1). The annual number of telemedicine consultations increased sharply from around 3.1 million in 2019 to 8.7 million in 2020, peaked at 8.8 million in 2021, and then declined sharply to 6.5 million in 2022 and 4.3 million in 2023. Despite this decline, the total number of telemedicine consultations remained higher in 2023 than in 2019.

Table 1.

Telemedicine consultations provided through MOH services (2019–2023).

Telemedicine service	2019	2020	2021	2022	2023	Total (2019–2023)
937 service	2,577,570	7,213,897	8,135,616	5,852,187	3,323,876	27,103,146
Sehhaty app	559,709	1,284,824	528,835	501,550	753,996	3,628,914
Wasfaty system	20,508	158,956	70,764	99,025	236,217	585,470
X platform	25,664	41,984	50,085	27,545	15,387	160,665
Annual Total	3,185,470	8,701,681	8,787,321	6,482,329	4,331,499	31,478,195

Proportional contribution of each telemedicine service

As shown in Figure 1(a), telemedicine utilization was highly concentrated in the 937 service throughout the study period, which accounted for 86.1% of all consultations, followed by the Sehhaty app, which accounted for 11.5%.

Figure 1.

Proportion of telemedicine consultations delivered via each service from 2019 to 2023.

As shown in Figure 1(b), most telemedicine consultations were delivered through the 937 service throughout the study period, ranging from 80.9% in 2019 to 76.7% in 2023, followed by the Sehhaty app, which accounted for 17.6% in 2019, declining to 6.0% in 2021 and 7.7% in 2022, before recovering to 17.4% in 2023. The Wasfaty system accounted for a small but increasing proportion of total telemedicine consultations, reaching 5.5% in 2023. In contrast, the X platform accounted for only a small and declining proportion of telemedicine consultations throughout the study period.

Annual and cumulative changes in telemedicine consultations

Changes in the utilization of the different telemedicine services between 2019 and 2023 are shown in Figure 2. Relative to the previous year, the number of telemedicine consultations delivered through the 937 service increased substantially by 179.9% in 2020, before declining in subsequent years (Figure 2(a)). Similarly, the number of telemedicine consultations delivered through the Sehhaty app increased by 129.6% in 2020, then declined by −58.8% in 2021 and by −5.2% in 2022, before recovering in 2023 (50.3%, Figure 2(b)). The number of telemedicine consultations delivered through the Wasfaty system showed the largest annual growth, increasing significantly by 675.1% in 2020 and by 138.5% in 2023, despite fluctuations in intervening years (Figure 2(c)). In contrast, telemedicine consultations delivered through the X platform increased modestly by 63.6% in 2020 and by 19.3% in 2021 before declining by −45.0% in 2022 and by −44.1% in 2023 (Figure 2(d)).

Figure 2.

Trends in telemedicine consultations by service from 2019 to 2023.

Relative to the 2019 baseline, cumulative growth by 2023 remained positive for the 937 service (29.0%, Figure 2(a)), the Sehhaty app (34.7%, Figure 2(b)), and the Wasfaty system (1051.8%, Figure 2(c)), but declined for the X platform (−40.0%, Figure 2(d)).

Satisfaction with telemedicine consultations

User satisfaction data were available only for the 937 service and the Sehhaty app. The percentage of users satisfied with the 937 service and the Sehhaty app is shown by year in Figure 3. In general, most users were satisfied with both services throughout the study period. In particular, user satisfaction with the 937 service remained consistently high across the study period (87.2%–98.1%), with the lowest satisfaction recorded in 2021. In contrast, user satisfaction with the Sehhaty app was more variable and was consistently lower than that of the 937 service. In general, user satisfaction with the 937 service consistently increased after 2020, while user satisfaction with the Sehhaty app mostly declined.

Figure 3.

User satisfaction with telemedicine consultations delivered through the 937 service and the Sehhaty app from 2019 to 2023.

Discussion

Consistent with ongoing health sector reforms in Saudi Arabia, this retrospective comparative study analyzed trends in user utilization and satisfaction with telemedicine consultations delivered through MOH services. The findings showed significant growth in telemedicine consultations between 2019 and 2023, although this growth varied across years and service types. The 937 service was the most popular telemedicine consultation channel, while the X social media platform was the least used. The use of telemedicine services was significantly higher in 2020 and 2021 than in the other years. User satisfaction remained relatively high for the 937 service throughout the study period, but declined for the Sehhaty app.

The findings reveal how the social distancing and isolation rules imposed during the COVID-19 pandemic led to a significant increase in telemedicine consultations in Saudi Arabia between 2020 and 2021. This observation aligns with trends identified in both national and international contexts. For example, telemedicine service utilization increased by 230% in Argentina during the COVID-19 pandemic.²⁶ A recent review highlighted significant advancements in telemedicine in Saudi Arabia during the COVID-19 pandemic, along with a positive shift in public behaviors and attitudes toward these services.²⁷ The increase in telemedicine consultations during the COVID-19 pandemic highlights the ability of the Saudi Arabian healthcare system to rapidly respond and adapt to emerging challenges caused by pandemics.

The growth in demand for telemedicine consultations during the COVID-19 pandemic can be attributed to several factors, including restrictions on in-person visits to healthcare facilities except for urgent medical issues and suspected COVID-19, limitations imposed by quarantine and curfew measures, the desire to avoid COVID-19 infection, the need to book appointments for COVID-19 testing and vaccines, and the regular reporting of COVID-19 symptoms and post-vaccination side effects.^27–29 However, these near-mandatory practices and widespread implementation of telemedicine services during the COVID-19 pandemic likely improved their later acceptance among both service providers and the public.

The decline in telemedicine service utilization after the COVID-19 pandemic has raised concerns about the lack of sustained development to maintain these services. Indeed, Alkhalifah et al.²⁷ raised concerns about the sustainability of interest in telemedicine services. Nonetheless, several studies have highlighted the key role that telemedicine services play in advancing and improving access to healthcare services, highlighting the need for their continued development.^2,30

Among the telemedicine services available in Saudi Arabia, the 937 service ranked first in both the number of telemedicine consultations and user satisfaction. Alhraiwil et al.³¹ highlighted the central role of the 937 service in providing remote medical consultations, especially during the COVID-19 pandemic, where the number of calls increased by 296%. Al-Shroby et al.³² found that 91% (n = 2,306) of their participants were satisfied with the provided 937 service. User satisfaction with the 937 service in the current study, ranging from 87.2% to 98.1% across the study period, was consistently higher than that reported for all MOH services, including face-to-face consultations (74.4%–81.3%).³³

Given the steady increase in telemedicine consultation volume and satisfaction with the 937 service, it is important to analyze its popularity among users. Potential factors include ease of use and the ability to allow users to communicate directly with healthcare professionals. It is also free from the complexities and technical challenges that some users may face with alternative virtual services. In particular, this service does not require the use of programs, applications, or passwords, making it more approachable for those unfamiliar with such technology. A recent study by Busso et al.²⁶ appears to support this interpretation, suggesting that the increase in telemedicine call services was partly driven by greater familiarity with these services among older adults. They also showed that the telemedicine call service is considered a good experience and has a relatively low cost, thereby improving healthcare access. However, it is worth noting that previous evidence showed that long waiting times were the most frequent reason for dissatisfaction among 937 service users.³⁴

Although Saudi Arabians constitute a large segment of the X platform’s user base,³⁵ and despite the MOH’s use of this social media platform for public communication and health education activities,³⁶ user uptake for telemedicine consultations delivered through X was low, except during the COVID-19 pandemic, when the number of consultations doubled. The increased use of the X platform for telemedicine consultations during the COVID-19 pandemic is likely attributable to the increased pressure on other digital channels and to more restrictive quarantine and curfew measures, leading the public to spend more time on social media. Consequently, the X platform became a central channel for expressing feelings and sharing information.³⁷

Usage of the Sehhaty app varied across the study period, resulting in a small but consistent decrease in user satisfaction, which reached 78.0% in 2023. User satisfaction with the Sehhaty app remained below the overall satisfaction reported for in-person MOH services, which increased consistently over the same period.³³ A recent cross-sectional study by Alzghaibi³⁸ explored the barriers to utilizing the Sehhaty app in Saudi Arabia. It showed that technical issues, usability challenges, and privacy concerns impacted user satisfaction, particularly among older adults and individuals with disabilities. In addition, a mixed-methods study conducted in Saudi Arabia by Alhodaib and Alanzi³⁹ revealed disparities in ease of access, utilization, and perceptions of digital health services, including the Sehhaty app, across different demographics. Specifically, certain population groups reported challenges in ordering medications and personal medical equipment, as well as a lack of personalized care. For example, older adults experienced greater difficulty in accessing digital health services than younger adults.

Other challenges, including limited digital health literacy and language barriers, have been identified as key obstacles to the adoption and effective use of digital health services in Saudi Arabia.^40–42 The non-Saudi population exceeds 15 million, accounting for approximately half of the total population.⁴³ Most non-Saudi residents originate from countries where the predominant languages are not Arabic or English, such as Bangladesh, India, and Pakistan. However, digital healthcare services in Saudi Arabia are available only in Arabic and English.⁵ Therefore, to support the goals of digital health transformation in Saudi Arabia, the Sehhaty app requires review and improvements to address the challenges of utilization and enhance user satisfaction.³⁸ For example, it could be improved by enhancing its ease of use and navigation.^38,44,45 Its accessibility could also be strengthened, particularly for older adults and users with limited digital skills, by simplifying the interface, improving communication features, and providing user support and training.^38,44,45 Its functionality could also be strengthened through better tracking of health data and stronger integration with other health services and systems. Finally, its efficiency and user experience could be enhanced by reducing the number of steps and the time required to complete tasks.^38,44,45

The Wasfaty system recorded the highest growth among telemedicine consultation services, though it still accounted for a relatively small share of all telemedicine consultations across the study period. The significant increase in the use of the Wasfaty system, particularly in 2023, may reflect the growing acceptance and importance of digital prescription services. Despite some variation over time, the overall trend suggests strong long-term potential. However, it requires further improvements in its navigation, communication with prescribers, and medication shortages.^46,47 Integrating the Wasfaty system with other digital health channels may also help support its continued adoption.

Telemedicine services have successfully attracted a larger user base, thus improving healthcare access and relieving the burden on in-person services in Saudi Arabia. This trend highlights the importance of the Health Sector Transformation Program under Saudi Vision 2030, which identified digital platforms and e-health as key focal points of health sector reform.⁸

Implications for healthcare leadership

The significant increase in telemedicine consultation volume observed in this study highlights the importance of telemedicine services for optimizing patient care. It also indicates the role of effective leadership in maintaining and further developing these virtual healthcare services. Therefore, the findings have several important implications for healthcare leadership.

Firstly, it is necessary to ensure the efficiency and sustainability of telemedicine services within the current healthcare model. Therefore, healthcare leadership should prioritize adopting accessibility measures, improving performance, securing continued funding, and regularly reviewing quality indicators. They should also consider operational strategies to maximize service utilization. For example, healthcare curricula and practical training should integrate telemedicine as early as possible to help students become familiar with digital modes of care delivery.⁴⁸ Local healthcare providers should also be prepared and encouraged to use telemedicine for routine cases that can be managed remotely. These steps will help normalize telemedicine services into daily healthcare routines, reduce the load on in-person services, and keep pace with growing demand and evolving user needs.

Secondly, although the roles of health platforms are clear, priority should be given to their practical integration to enable patients to navigate these services smoothly, including booking appointments, consultations, prescriptions, follow-ups, and transfers. This integration would help reduce duplication and complexity of health platforms, improve service delivery, and enhance the patient experience. User experience plays a key role in the adoption of telemedicine services, with positive initial experiences improving long-term usage.⁴⁹

Thirdly, the effective and equitable expansion of telemedicine services requires ensuring they are accessible to everyone, including vulnerable populations such as older adults, individuals with disabilities, those who do not speak Arabic or English, and those who are unfamiliar with digital tools. The emphasis should be on simplifying digital procedures and improving ease of use by addressing users’ actual needs, rather than prioritizing developers’ technical perspectives. Although this study did not include demographic data on telemedicine use, previous studies have identified these challenges as factors contributing to lower satisfaction and utilization among these populations.^38,44,50

Finally, there is a need to strengthen high-impact services and review less effective ones. The 937 service maintained relatively high utilization and user satisfaction throughout the study period, indicating broad acceptance and the ability to meet users’ needs. However, it requires greater investment as the primary entry point for telemedicine and routine healthcare services. In contrast, Sehhaty app usage varied across the study period, experiencing a slight but consistent decline in user numbers and satisfaction. This finding suggests that the Sehhaty app needs to be reviewed and improved to enhance user experience. Although the Wasfaty system accounted for only a small share of all telemedicine consultations, it showed the highest growth among the examined telemedicine services. Therefore, it represents a telemedicine service that requires more funding, support, and expansion to become widely accepted by the public and healthcare providers. In contrast, the X platform showed limited use and should be evaluated for its viability as a telemedicine consultation channel. It could instead be retooled as a public education and communication channel. Furthermore, research on development should be supported to help decision-makers understand the reasons for differences in usage and satisfaction across these telemedicine services. Achieving these goals will promote public health, inform managerial decision-making, and enhance the quality of in-person and telemedicine services.

However, this study had several limitations that should be acknowledged. Firstly, it analyzed secondary data, making the validity of its findings strongly dependent on the quality of the primary data collected. However, these data were collected and shared by the MOH, the governmental body responsible for health-related data collection and dissemination in Saudi Arabia.⁵¹ Secondly, this analysis was limited to the indicators available in the original dataset. Consequently, user satisfaction was only available for two of the examined telemedicine consultation services: the 937 service and the Sehhaty app. However, no information was provided on either the number of respondents or the methods used to collect the user satisfaction data. Thirdly, stratified analyses by region and population characteristics were not possible because the original dataset provided only aggregated national data. However, this study focused on national trends in the acceptance and use of the examined services following the introduction of the Saudi Vision 2030. Finally, the analysis covered only five years, from 2019 to 2023. A longer timeframe would have enabled a more comprehensive understanding of trends in telemedicine use and satisfaction.

Nevertheless, this study offers valuable insights into the trends in telemedicine consultations across the study period. It also provides a foundation for further longitudinal comparisons and future analyses of primary data.

Conclusion

This study revealed a general increase in the use of telemedicine consultations across the 937 service, the Sehhaty app, and the Wasfaty system. This trend reflects the growing importance of these services in modern healthcare delivery in Saudi Arabia, highlighting their strong potential to improve healthcare access. Sustaining this progress will depend on strong leadership to improve and integrate these platforms, ensure equitable access for all populations, and enhance user satisfaction with these services. In contrast, the X platform showed limited use and requires further evaluation of its viability as a telemedicine consultation channel. Such steps can help telemedicine services better complement in-person care and respond to evolving population needs.

Footnotes

Acknowledgement

The author expresses gratitude to Sami M. Almalki and Maram M. Almalki for their assistance in formatting and editing the whole manuscript.

ORCID iD

Mohammed J. Almalki

Ethical considerations

This study received ethical approval from the Committee for Research Ethics at Jazan University (reference no. REC-47/09/1806).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analyzed during this study are available in the Saudi Open Data Platform: .²²

Contributorship

Mohammed J. Almalki is the only author of this manuscript.

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