A Theory of Rural Telehealth Innovation - A Paradoxical Approach

Telehealth promises to provide underserved communities with better medical services and to help rural healthcare institutions become financially sustainable. However, these institutions find it challenging to implement telehealth because their resources are severely constrained even to maintain current operations. This paper investigates how a rural health institution successfully addressed this paradoxical situation by integrating telehealth into its operations over a 20-year period. We identify three sets of tensions that manifest during the telehealth implementation process: autonomy vs. dependence (relating to resource acquisition), controlling vs. drifting (relating to enabling the innovation), and exploration vs. exploitation (relating to creating a sustainable solution). Drawing on Poole and Van de Ven’s (1989) paradoxical approach, we develop four propositions comprising a theory of rural telehealth innovation. We suggest that three paradoxes shape rural telehealth innovation: Paradox of Alliance, Paradox of Governance, and Paradox of Learning, and explain how innovation unfolds in response to these paradoxes

A Contextualist Approach to Telehealth Innovations

A Contextualist Approach to Telehealth Innovations By Sunyoung Cho Abstract Healthcare is considered one of the most important social issues in the U.S. as well as in other societies with ever-increasing costs of medical service provision. The information-intensive nature of the healthcare industry and the perception of information technology (IT) as a way to ease up healthcare costs and improve quality have lead to increased use of and experiments with IT-based innovations. These activities present interesting research opportunities for IS researchers and they have led to an increasing body of knowledge on healthcare information systems. This research aims at contributing to this line of research by adopting a contextualist approach to examine the adoption, use, and further diffusion of telehealth innovations. A contextualist approach provides a particularly interesting and relevant perspective to study adoption and diffusion processes of healthcare innovations. The adopted contextualist approach is process-oriented, it applies multiple levels of analysis, and it accommodates different theoretical lenses to make sense of the two telehealth innovations under investigation. A key assumption is that innovations should be understood as ongoing processes of change, not just technologies, or isolated change events with clear boundaries. Healthcare innovations have in this view much broader connotations, including development of IT-based applications, their adoption and diffusion over time, and the interactions between many stakeholders and organizations that shape the innovation in a specific context. The contextualist approach suggested by Pettigrew is adopted as an overarching framework for multiple studies based on empirical investigation of two telehealth innovations; the main focus is on a telestroke innovation in the U.S. while a radiology innovation in Sweden serves as a complementary case. Each study is documented as an independent research publication with its own theoretical perspective and contributions. The overall contextualist approach and the related findings are then summarized across the individual studies. Telehealth innovations are particularly interesting examples of healthcare information systems. They leverage contemporary network infrastructures and interaction devices to allow provision of healthcare services, clinical information, and education over distance, thereby reducing the costs and improving the availability of medical services. The two telehealth innovations are investigated through in-depth case studies. This theses summary presents the theoretical background for the studies; it motivates and details how the qualitative case studies based on critical realist assumptions were designed and conducted; it outlines the resulting research publications; and it discusses the contributions of investigating telehealth innovations from a contextualist approach

Competing Concerns in Welfare Technology Innovation: A Systematic Literature Review

Welfare technologies (WT) such as telecare and service robots are expected to improve and even radically transform service delivery in health- and eldercare. Yet despite political awareness and financial investments, many studies report promising inventions that fail to become implemented on a larger scale. Current research draws a fragmented and heterogeneous picture of this problem, with divergent implications for practice. In this article, I review and discuss the extant literature and identify eight competing concerns that are central to how WT can become implemented on a large scale. By highlighting and contrasting practical and theoretical positions in this emerging and interdisciplinary research topic, I contribute conceptually to the understanding of the competing concerns in WT innovation that managers and policy-makers must balance in order to support the critical transition from small-scale invention to large-scale implementation

Telemedicine Evaluation

This paper examines the context and status of evaluation research in telemedicine, and it proposes a two-pronged strategy for addressing the critical policy and programmatic concerns in this field. It explains the evolution of evaluation research in the United States, and it describes a comprehensive typology and requirements for valid evaluation. Major impediments for definitive evaluation are discussed, together with a summary of major trends in empirical studies. Two concurrent strategies are proposed for producing definitive findings and for assessing the available empirical evidence. These consist of large-scale experimental studies and theoretical and empirical triangulation for assessing the available empirical evidence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63176/1/tmj.2005.11.296.pd

Characteristics of successfully implemented telemedical applications

<p>Abstract</p> <p>Background</p> <p>There has been an increased interest in the use of telemedical applications in clinical practice in recent years. Considerable effort has been invested in trials and experimental services. Yet, surprisingly few applications have continued beyond the research and development phase. The aim of this study is to explore characteristics of successfully implemented telemedical applications.</p> <p>Methods</p> <p>An extensive search of telemedicine literature was conducted in order to identify relevant articles. Following a defined selection process, a small number of articles were identified that described characteristics of successfully implemented telemedical applications. These articles were analysed qualitatively, drawing on central procedures from Grounded Theory (GT), including condensation and categorisation. The analysis resulted in a description of features found to be of importance for a successful implementation of telemedicine. Subsequently, these features were discussed in light of Science and Technology studies (STS) and the concept of 'social negotiation'.</p> <p>Results</p> <p>Telemedical applications introduced into routine practice are typically characterised by the following six features: 1) local service delivery problems have been clearly stated, 2) telemedicine has been seen as a benefit, 3) telemedicine has been seen as a solution to political and medical issues, 4) there was collaboration between promoters and users, 5) issues regarding organizational and technological arrangements have been addressed, and 6) the future operation of the service has been considered.</p> <p>Conclusion</p> <p>Our findings support research arguing that technologies are not fixed entities moving from invention through diffusion and into routine use. Rather, it is the interplay between technical and social factors that produces a particular outcome. The success of a technology depends on how this interplay is managed during the process of implementation.</p

Digitalization and civic participation in rural areas: A systematic review of scientific journals, 2010-2020

Das smart village ist digital vernetzt und partizipativ. Seine angenommene smartness soll also auf der Verschränkung von technologischen Infrastrukturen und der Beteiligung der lokalen Bevölkerung beruhen. Doch obschon diese Vision in den letzten Jahren die europäische Politikgestaltung wie den öffentlichen Diskurs beflügelt hat, ist das Verständnis der Wechselwirkungen zwischen Digitalisierung und Partizipation in ländlichen Räumen noch begrenzt. Um diese Lücke zu schließen, stellt dieser Beitrag eine systematische Literaturschau zur Digitalisierung im Zusammenspiel mit Partizipation in ländlichen Räumen vor. Insgesamt wird dabei deutlich, dass die digitale Entwicklung im ländlichen Raum immer noch ein Nischenthema in wissenschaftlichen Zeitschriften ist. Ein zentraler Fokus lag in den einbezogenen Studien auf Projekten des Breitbandausbaus. Darüber hinaus wurden häufig die räumlich bedingten Merkmale ländlicher Gebiete diskutiert, in denen soziale Beziehungsgefüge und Intermediäre eine wichtige Rolle spielen. Schließlich wurde die Verschränkung von top-down-Maßnahmen mit bottom-up-Initiativen betont. Es fand sich kein dominanter theoretischer Ansatz, um das Ineinander von Digitalisierungs- und Partizipationsprozessen in ländlichen Räumen zu konzeptualisieren. Die Synopse unterstreicht die Wichtigkeit lokaler sozialer Netzwerke, die mittels analoger und digitaler Formate aufrechterhalten werden. Darüber hinaus liefert die Literatur Hinweise darauf, dass nachhaltige Formen digitalen Engagements auf zivilgesellschaftlichen Initiativen beruhen, die durch administrative Maßnahmen unterstützt und begleitet werden.The smart village is digitally networked and participatory. Its 'smartness', in other words, should be based on interaction between technological infrastructures and civic engagement. While this vision has inspired European policymaking and public discourse in recent years, understanding of the interaction between digitalization and civic participation in rural areas remains limited. In order to fill this gap, this paper offers a systematic review of journal contributions situated at the intersection of digitalization, participatory efforts and rural development. Overall, our study shows that digital rural development and its interplay with participation processes is still a niche concern in scientific journals. We find that articles focus primarily on projects seeking to increase broadband capacity. Second, they focus on the spatial characteristics of rural areas, where social relations and intermediaries play an important role. Third, they emphasize the integration of topdown measures with bottom-up initiatives. There is no single, dominant theoretical approach conceptualizing the intertwining of digitalization and civic participation processes in rural areas. It is evident that local social networks are strengthened and maintained through both analogue and digital formats. Furthermore, the literature provides evidence that sustainable forms of digital engagement are based on civil society initiatives that are supported and accompanied by administrative measures

A paradox theory perspective on HIT’s impact on continuity of care

Regulators of healthcare systems continue to investigate ways to improve continuity of care (COC) for patients given its inherent fragmented nature. Integrated healthcare information technology (HIT) system is touted as one of the ways to improve COC. Yet, studies show that there are still challenges in achieving effective COC even when supported by integrated HIT. These persistent challenges are likely due to deep-seated tensions among the various parts of the healthcare system that are involved in providing care. Drawing on HIT impact literature and paradox theory, we study the implementation of an integrated electronic medical record (EMR) system aimed at improving COC for the specialist referrals process in a hospital cluster. We found that while the system had positive impacts on some aspects of the COC, we uncover two types of paradoxical tensions occurring in this healthcare context that interfered with those positive impacts and contributed to ongoing COC challenges

the Performative Cohesion of Organizing Visions

We link the concept of an ‘organizing vision’ to the idea of ‘performativity’ in order to better understand the challenges associated with implementing integrated care, i.e. the usage of ICT in order to coordinate medical treatments of the same patient by multiple medical professionals. More specifically, we focus on how medical autonomy affects the performativity of an organizing vision. Through an inductive case study of one German integrated care provider, we indicate that medical autonomy seems to be positively related to adoption decisions of ICT by medical professionals if an ICT-based business model embraces medical autonomy. However, through looking at the first four years of the implementation process, we also find that medical autonomy seems to be negatively related to important ICT-related outcomes of integrated care. Our study implies that a focus only on how actors translate organizing visions may run the risk of underemphasizing context factors that affect the adoption of integrated care on the organizational level. To depict how such contexts influence the degree at which an organizing vision is performative, we introduce the concept of ‘performative cohesion’.1. Auflag

Exploring the Efficacy of the Helen B. Landgarten Art Therapy Clinic’s Transition to Telehealth During COVID-19

This research qualitatively explores the impacts of the Helen B. Landgarten Art therapy Clinic’s transition to art therapy telehealth services during the COVID-19 pandemic. The purpose of this research was to explore the efficacy of interventions and the clinical themes that emerged as a result of telehealth art therapy services delivered to marginalized communities through the Helen B. Landgarten Art Therapy Clinic. Data that was collected includes anonymous surveys from administrators, teachers, and caregivers of those receiving services and facilitators of services, semi-structured interviews with administrators, teachers, and caregivers of those receiving services, as well as a focus group with facilitators of services. Through the analysis of data several findings suggest that art therapy telehealth can provide a safe space for engagement in mental health and be more accessible to marginalized communities. These findings potentially open new doors for further inquiry into art therapy telehealth