Understanding the normalization of telemedicine services through qualitative evaluation
Open Access
- 31 December 2003
- journal article
- Published by Oxford University Press (OUP) in Journal of the American Medical Informatics Association
- Vol. 10 (6), 596-604
- https://doi.org/10.1197/jamia.m1145
Abstract
Objective: Qualitative studies can help us understand the “successes” and “failures” of telemedicine to normalize within clinical service provision. This report presents the development of a robust conceptual model of normalization processes in the implementation and development of telemedicine services. Design: Retrospective and cumulative analysis of longitudinal qualitative data from three studies was undertaken between 1997 and 2002. Observation and semistructured interviews produced a substantial body of data relating to approximately 582 discrete data collection episodes. Data were analyzed separately in each of three studies. Cumulative analysis was conducted by constant comparison. Results: (1) Implementation of telemedicine services depends on a positive link with a (local or national) policy level sponsor. (2) Adoption of telemedicine systems in service depends on successful structural integration so that development of organizational structures takes place. (3) Translation of telemedicine technologies into clinical practice depends on the enrollment of cohesive, cooperative groups. (4) Stabilization of telemedicine systems in practice depends on integration at the level of professional knowledge and practice, where clinicians are able to accommodate telemedicine through the development of new procedures and protocols. Conclusion: A rationalized linear diffusion model of “telehealthcare” is inadequate in assessing the potential for normalization, and the political, organizational, and “ownership” problems that govern the process of development, implementation, and normalization need to be accounted for. This report presents a model for assessing the potential for successful implementation of telehealthcare services. This model defines the requirements for the successful normalization of telemedicine systems in clinical practice.Keywords
This publication has 44 references indexed in Scilit:
- Remote Doctors and Absent Patients: Acting at a Distance in Telemedicine?Science, Technology, & Human Values, 2003
- Health technology assessment in its local contexts: studies of telehealthcareSocial Science & Medicine, 2003
- The theory of use behind telemedicine:: how compatible with physicians’ clinical routines?Social Science & Medicine, 2002
- Limitations of Patient Satisfaction Studies in Telehealthcare: A Systematic Review of the LiteratureTelemedicine and e-Health, 2001
- Evaluating informatics applications—clinical decision support systems literature reviewInternational Journal of Medical Informatics, 2001
- Factors affecting the adoption of telehealthcare in the United Kingdom: the policy context and the problem of evidenceHealth Informatics Journal, 2001
- Toward an Informatics Research Agenda: Key People and Organizational IssuesJournal of the American Medical Informatics Association, 2001
- Evaluation of new technologies in health-care systems: what’s the context?Health Informatics Journal, 2000
- The Diffusion of TelemedicineScience Communication, 1997
- Challenges to the Implementation of TelemedicineTelemedicine Journal, 1995