Modelling the barriers of Health 4.0–the fourth healthcare industrial revolution in India by TISM Puneeta Ajmera 1 & Vineet Jain 2 Received: 6 February 2019 /Revised: 16 July 2019 /Accepted: 17 July 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract In healthcare industry, the phenomenon of Industry 4.0 is popular as Health 4.0 where the modern technologies are integrated with available data along with the use of artificial intelligence. The main objective of this paper is to explore the barriers of Health 4.0 application in healthcare sector in India. Fifteen barriers which can affect the adoption of Health 4.0 in the Indian healthcare sector have been identified through extensive literature review and opinions of healthcare industry and academic experts. ATISM (Total Interpretive Structural Modelling) model has been developed to extract the key barriers influencing Health 4.0 adoption which will guide the healthcare managers and decision makers to explore the effect of each barrier on other barriers as well as the degree of relationships among them. The result shows that lack of top management support, exclusive and skilled workforce requirement, inadequate maintenance support systems and political support are the major barriers as they have strong driving power. Timely action taken by the management to remove these hurdles will not only reduce the cost of medical procedures but also improve the quality of treatment so that the true potential of Health 4.0 can be utilized. Keywords Industry 4.0 . Health 4.0 . Health 4.0 barriers . Healthcare industry . Healthcare industrial revolution . Total interpretive structural modelling . MICMAC analysis 1 Introduction The Industrial Revolution is considered to be one of the most significant landmark in the history which impacted all the aspects of life in one way or the other. Technological advance- ments and industrialization led to the development of highly automated and motorized manufacturing processes giving rise to evolution of factory system Kamble et al. (2018). The first industrial revolution occurred with the invention of steam en- gine by Thomas Newcomen in the late eighteenth century which led to the use of steam to make machines causing the development of textile, coal and iron industry. This resulted in urbanization and increased communications and people moved to those cities where they could work as operators in factories. To provide accommodation to these people, houses of cheaper quality were built and community wells were the only source of drinking water. Facilities for sewage removal were hardly present. This led to the deterioration of health and spread of diseases like typhoid, cholera, tuberculosis, fever, smallpox and plague etc. Side by side many medical innova- tions were made due to advancement in science and technol- ogy and scientific causes of some diseases were explored. In 1796, Edward Jenner was successful in developing smallpox vaccination. Before this, there was no awareness about the causes of spread of diseases and remedies were dependent upon several superstitions and speculations. In the 1850s, Louis Pasteur discovered that the causes of disease were mi- croorganisms. Healthcare industry in that era witnessed the inception of modular information system technologies and that period was known as Health 1.0 (Bodenheimer 1995; Thuemmler and Bai 2017). Second industrial revolution was another transition in technology focussing on the extensive use of electrical energy, petroleum and steel for creating mass production. Improved factories and contemporary technolo- gies gave rise to the discovery of microscopes and other med- ical equipment. Simple networking was introduced in healthcare industry with the evolution of Electronic Health * Vineet Jain vjdj2004@gmail.com Puneeta Ajmera puneeta_22@yahoo.com 1 Department of Hospital Administration, Amity Medical School, Amity University Haryana, Gurgaon, India 2 Department of Mechanical Engineering, Mewat Engineering College, Palla, District Nuh, Mewat, Haryana 122107, India Operations Management Research https://doi.org/10.1007/s12063-019-00143-x