Introduction: Telemedicine is the delivery of health care services when distance is a critical factor by all health care professionals using information and communication technology. And it is used as part of health system since 1973 worldwide. However, the facilitators and barriers of telemedicine adoption were not studied well in Amhara region, Ethiopia. Objective: The main objective of this study is to explore barriers and Facilitators to telemedicine adoption in the Amhara Region, North West Ethiopia, 2022. Methods: A phenomenology study design was conducted on 20 Health system Leaders in Amhara Region from April 1 to July 10, 2022. A heterogeneous purposive sampling technique was used to select 20 participants. Data were collected through in-depth interview guide and Focus group discussion. The data were recorded, transcribed; translated by principal investigator and the data were managed and Analysis assisted by ATLAS.ti7.0.91 qualitative software by using inductive thematic Analysis. Results: In this study, seven major themes were emerged: technology and infrastructure, legal Frame work and regulations, awareness, attitude and commitment, budget and resources as a barriers and current global and national situations, health professional and health policy as facilitators. The poor accesses and quality of IT infrastructure and medical equipment, no clear guidance and low commitment of health system leaders are the major identified barriers for adopting telemedicine. The presence of national health policy that promote digitalization of the health system, readiness of health professionals, rapid ICT development and public health emergencies are identified as the facilitators of telemedicine adoption in the Amhara Region. Conclusion and Recommendation: Due to technological, financial, Legal and Policy related barriers telemedicine is not adopted yet in Amhara Region. The Federal ministry of Health and Amhara Regional Health Bureau Should take commitment to adopt telemedicine by providing clear direction and allocate budget with strict Follow Up. Key words; Adoption of telemedicine, Barriers, facilitators