PurposeVirtual and augmented reality solutions in medicine are generally applied in communication, training, simulation and therapy. However, like most new digital developments, these technologies face a large number of institutional barriers that are inherent to the medical sector.Design/methodology/approachFollowing Richard Scott's view on institutions and organizations, a multiple case study is used to analyze regulatory, normative and cultural-cognitive institutional pillars in the medical industry.FindingsThe results of the study demonstrate that (1) the regulatory pillar inhibits the advancement of new technologies in the approach to treatment, regulation of patient data, educational processes for medical staff, and information and financial flows; (2) the number of barriers increases based on the solution's level of disruption and the number of variable conventional procedures; (3) trust between participants in the medical industry plays an important role in introducing new technologies; (4) new participants need to address certain pillars depending on the area of application.Originality/valueThe authors discuss top-down and bottom-up approaches for overcoming institutional barriers when implementing augmented and virtual reality solutions for companies focusing on the medical market.