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

A Multi-Dimensional Approach for Framing Crowdsourcing Archetypes

All different kinds of organizations – business, public, and non-governmental alike – are becoming aware of a soaring complexity in problem solving, decision making and idea development. In a multitude of circumstances, multidisciplinary teams, high-caliber skilled resources and world-class computer suites do not suffice to cope with such a complexity: in fact, a further need concerns the sharing and ‘externalization’ of tacit knowledge already existing in the society. In this direction, participatory tendencies flourishing in the interconnected society in which we live today lead ‘collective intelligence’ to emerge as key ingredient of distributed problem solving systems going well beyond the traditional boundaries of organizations. Resulting outputs can remarkably enrich decision processes and creative processes carried out by indoor experts, allowing organizations to reap benefits in terms of opportunity, time and cost. Taking stock of the mare magnum of promising opportunities to be tapped, of the inherent diversity lying among them, and of the enormous success of some initiative launched hitherto, the thesis aspires to provide a sound basis for the clear comprehension and systematic exploitation of crowdsourcing. After a thorough literature review, the thesis explores new ways for formalizing crowdsourcing models with the aim of distilling a brand-new multi-dimensional framework to categorize various crowdsourcing archetypes. To say it in a nutshell, the proposed framework combines two dimensions (i.e., motivations to participate and organization of external solvers) in order to portray six archetypes. Among the numerous significant elements of novelty brought by this framework, the prominent one is the ‘holistic’ approach that combines both profit and non-profit, trying to put private and public sectors under a common roof in order to examine in a whole corpus the multi-faceted mechanisms for mobilizing and harnessing competence and expertise which are distributed among the crowd. Looking at how the crowd may be turned into value to be internalized by organizations, the thesis examines crowdsourcing practices in the public as well in the private sector. Regarding the former, the investigation leverages the experience into the PADGETS project through action research – drawing on theoretical studies as well as on intensive fieldwork activities – to systematize how crowdsourcing can be fruitfully incorporated into the policy lifecycle. Concerning the private realm, a cohort of real cases in the limelight is examined – having recourse to case study methodology – to formalize different ways through which crowdsourcing becomes a business model game-changer. Finally, the two perspectives (i.e., public and private) are coalesced into an integrated view acting as a backdrop for proposing next-generation governance model massively hinged on crowdsourcing. In fact, drawing on archetypes schematized, the thesis depicts a potential paradigm that government may embrace in the coming future to tap the potential of collective intelligence, thus maximizing the utilization of a resource that today seems certainly underexploited

Introducing Wireless Grids Technology to the Field of Telemedicine

While telemedicine and technology-enabled education are not new concepts and have significant bodies of research, in depth application to management and treatment of veteran Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) is relatively new. The conflicts in the Southwest Asia over the last two decades have significantly increased the need for healthcare and support services for these returning warriors. Creative thinking and innovative technologies are needed to meet the growing and changing demand of these patients in the face of many competing demands within the U.S. healthcare sector. This doctoral research study investigated the potential for a platform-agnostic (ad hoc) networking technology to serve as a trusted social networking and training platform for healthcare providers who are striving to provide quality healthcare that meets the needs of veterans suffering from PTSD and TBI. This research study analyzed the effectiveness of a digitally networked environment to deliver desired training and certification outcomes in a military healthcare environment. The level of acceptance of an ad hoc network technology (GridstreamRx) by healthcare professionals using it as an enabler of collaboration during the training process was evaluated. The results also assessed the readiness of healthcare professionals to use this Information Communications Technology (ICT), or analogous new applications and services, to help them perform their healthcare responsibilities. This thesis study, accomplished with the support of the U.S. Army and National Science Foundation, took place at two large military medical centers over a twelve-month period of time. Data was gathered from 568 healthcare professionals using quantitative survey instruments. Ninety-six respondents provided additional quantitative and qualitative inputs at various times during a proscribed training regimen. DeLone and McLean\u27s 2003 Information System Success Model, modified by findings of more recent research, provided the theoretical lens for analyzing the data from 32 of the training participants in determining the perceived net benefit of the GridstreamRx technology. The data gathered for the study showed, at the 95% level of confidence, that a majority of the professionals of these two medical centers would perceive a positive net benefit from using GridstreamRx in a healthcare training environment. The conclusion from this analysis was that not only are the healthcare providers in this study ready to use ICT and social networking in this professional setting, but also that GridstreamRx is an acceptable platform for performing these functions. The study participants provided input with respect to their priorities regarding information sharing techniques, functionality, and suggestions for improving the platform. The outcomes confirmed that GridstreamRx can be a successful introduction of ad hoc networking to telemedicine. This thesis concluded with recommendations for scholars and practitioners to pursue in the future; and should be followed up with further research and actions in order to build toward a Fully Integrated Virtual Healthcare Environment (FivHe)

Exploring the impact of telehealth videoconferencing services on work systems for key stakeholders in New Zealand : a sociotechnical systems approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Albany, New Zealand

Figure 2.9 is re-used under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. Figures 2.11 and 2.13 are re-used with the publishers' permission.This thesis explores how the impacts of telehealth videoconferencing services (THVCS) on work systems are perceived by key stakeholders in New Zealand. Telehealth - the use of information and communications technologies to deliver healthcare when patients and providers are not in the same physical location - exemplifies how technological developments are changing the ways in which healthcare is provided and experienced. With the objectives of improving access, quality, and efficiencies of financial and human resources, THVCS use real time videoconferencing to provide healthcare services to replace travel to a common location. Despite the benefits of telehealth reported in the extant literature, there continues to be difficulties with developing and sustaining services. The aim of this inquiry is to understand how THVCS impact key stakeholders in the work system. Specifically, it seeks to examine the characteristics of THVCS in the New Zealand context, identify the facilitators and barriers to THVCS, and understand how the work system can adapt for THVCS to be sustained practice. The research design is framed by a post-positivist approach and underpinned by sociotechnical systems (STS) theory. STS theory and a human factors/ergonomics design approach inform the methodology, including the use of the SEIPS 2.0 model. Forty semi-structured qualitative interviews and contextual observations in a two-phase methodology explore the perceptions of an expert telehealth group, and providers, receivers, and decliners of THVCS. These data are analysed using the framework method of thematic analysis. The key findings suggest that to enable sustained THVCS in New Zealand, factors such as new ways of working; change; human connection; what is best for patient; and equity need to be recognised and managed in a way that balances costs and consequence and ensures fit across the work system. Theoretical contributions to knowledge are made through the development of a conceptual model from the literature, exploring THVCS with an STS theory lens and developing SEIPS 2.0. Methodologically, this inquiry contributes a theory-based, qualitative approach to THVCS research and draws on the perceptions of unique groups of participants. Significantly, the findings make practical contributions to the design of the THVCS in the New Zealand context

Enhancing the Benefits Management Model for Complex eHealth Efforts

This thesis suggests five ways to improve BM in complex eHealth efforts. First, the concept of BR was defined to clarify the existing conflation of the BR and BM concepts. Second, an extended and enhanced BMM was developed that incorporated the BM context, levels of complexity for both organizational and interorganizational initiatives, and the critical aspects of learning and governance. Third, three propositions concerning learning and governance in BM were suggested based on the new model, which can be used to inform future BM studies and guide empirical work. Fourth, the propositions were further translated into a six-question checklist to stimulate learning from the BM process itself. Finally, I provide suggestions for BM governance in interorganizational ICT efforts aiming to realize societal benefits.publishedVersio

A Systems-Based Patient Aid Design Artifact for Active Medication Management in Type 2 Diabetes

In this dissertation, I explore the use of the Abstraction-Decomposition Space (ADS) alongside Hierarchical Task Analysis (HTA) to guide the design of a minimalist patient aid for active medication management in type 2 diabetes. The goal is to address a practical problem, but in addition, this study seeks to address a theoretical problem that is prevalent in design research in Information Systems (IS) today. The practical problem concerns the need for IT-based care delivery models to support patients in the interim period between in-person visits. In this vein, I present a bare-minimum design that focuses on the most essential functionality required to achieve remote insulin titration using the ADS and HTA. The theoretical problem, on the other hand, pertains to the limitations resulting from taking a tool-focused view in design research which inhibits our ability to produce generalized knowledge about IT systems in their contexts. The study proposes an alternative view based on work systems. The overarching thesis is that a work systems view provides for knowledge at a more abstract and generalizable level, yielding contributions beyond mere software packages. Moreover, the study highlights the artifact-building methodology used to delineate the rationale behind the design and to balance evaluation-dominant design research. In this vein, I conducted document analysis and semi-structured interviews with patients and care providers to develop the ADS, then used it alongside HTA to develop and test the usability of twelve user scenarios implemented on a large mobile form factor

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

Current Practices, Perceptions and Challenges of Telehealth in the Treatment of Mental Health in the U.S. Department of Veterans Affairs

Currently there are 17,964,242 million Veterans living in the U.S. Around 50% of these Veterans are over 65 years of age. Many U.S. service members – both active and retired, experience trauma and dysfunction in restructuring their lives. Mental health problems are reported in over 50% of Veterans both in active service and retired. According to the U.S. Department of Veterans Affairs (VA), ten times more suicides are reported among Veterans who did not register with the VA compared to those who do register. Longer deployments, shorter times at home between the deployments and combat exposure are the greatest contributors of physical and psychological health problems. Combat exposure has been linked with most cases of PSTD. This creates a greater need for mental health services to Veterans than any other forms of treatment. Due to the complex nature of Veterans population, characterized by an aging majority and location of many Veterans in rural areas, delivering mental health services is a huge challenge for the VA. The VA has been making efforts to ensure that all Veterans can access mental health services from where they are. Out of these efforts, integration of telehealth services to improve access to mental health care services has yielded promising results but this is not without challenges. This dissertation explores the current practices, perceptions and challenges of telehealth in the treatment of mental health in the U.S. Department of Veterans Affairs (VA)

Aligning the Georgia Child Abuse & Neglect Prevention Plan with Governor Kemp\u27s Priorities and Initiatives

This work is a comprehensive issue brief outlines the causes and consequences of child abuse and neglect, how the Georgia Child Abuse & Neglect Plan provides guidance to address those problems, and how child- and family-serving providers and community leaders can operationalize the plan. The purpose of the brief is to align objectives of the Child Abuse & Neglect Plan with the Governor’s Priorities to implement prevention in all sectors throughout the state to create safe, stable, nurturing relationships and environments