Telehealth and information society: a critical study of emerging concepts in policy and practice

This thesis explores a number of interrelated factors that influence the development of telehealth. Telehealth refers to health-related services that can be provided in electronic form over various telecommunications networks, including applications beyond clinical settings and reaching out to communities and homes. As such this study encompass different disciplines and draws not only on the medical tradition but also on information systems, social theory and ideas of information society. The study is based on the fundamental claim that technology does not follow a pre-determinate path but is shaped by people, who in turn are constrained by historical conditions and current structures. The research takes into consideration a number of such defining structures, including the organisation of healthcare in Britain, the health policy process, strategies for the employment of information and communications technologies (ICTs), conflicting ethical traditions and their manifestations in evaluation processes, and visions of an information society. The theoretical position and research approach is informed by critical theory. Thus the work focuses on the different, often conflicting, interests of varied stakeholders. It also unveils factors constraining social aims to which telehealth could aspire, e.g. reducing social exclusion and supporting empowerment of patients and citizens. Insights into these concepts and their practical manifestations are explored through a set of linked case studies, which investigate a variety of telehealth projects and initiatives in the London Borough of Lewisham. The thesis' contribution is twofold - practical and theoretical. The practical contribution is aimed at those who work in and study telehealth, offering a new approach and focus that is not substantially found in other telehealth studies. In this the thesis makes a contribution to the ongoing debates about telehealth's potential implications for the healthcare process. The theoretical contribution is found in the thesis' re-affirmation of the applicability of critical theory to the development of ICT-based social and organisational innovations, re-conceptualised in the light of post-modern and information society theories

Transforming healthcare: policy discourses of ICT and patient-centred care

Information Technology (IT) is increasingly seen in policy and academic literature as key to the modernization of healthcare provision and to making healthcare patient-centred. However, the concept of Patient-Centred Care (PCC) and the role of IT in the transformation of healthcare are not straightforward. Their meanings need unpacking in order to reveal assumptions behind different visions and their implications for IT-enabled healthcare transformation. To this end, this paper analyses England’s health policy between 1989 and 2013 and reviews literature on PCC and IT. English policy has set out to transform healthcare from organization-centric to patient-centred and has placed IT as central to this process. This policy vision is based on contested conceptualizations of PCC. IT implementation is problematic and this is at least partly due to the underpinning goals and visions of healthcare policy. If this misalignment is not addressed then producing technologically superior systems, or better IT implementation strategies, is unlikely to result in widespread and substantial changes to the way healthcare is delivered and experienced. For IT to support a healthcare service that is truly patient-centred, patients’ needs and wants should be identified and designed into IT-enabled services rather than simply added on afterwards

Weaving Discourses and Changing Organizations: The Role of ICT in the Transformation of Healthcare Towards Patient-Centered Model

This paper illustrates ways in which ICT are implicated in transforming healthcare from an organization-centered model of delivery to a patient-centered model. Building on the literature on discourse analysis and organizational change it analyzes ICT-led organizational transformation and patient-centered healthcare discourses constructed in the UK’s policy papers and enacted in healthcare organizations. It suggests that ICT discourse performs different roles in relation to patient-centered healthcare discourse, and theorizes them as opening of possibilities, amplifying and re-focusing. The research reveals that Electronic Health Records both facilitate and obstruct the transformation of healthcare towards a patient-centered model. This contradiction arises from a number of contingent, interacting factors including different organizational characteristics, implementation strategies and work practice, as well as different conceptualizations of patient-centered care. Organizational transformation takes time and is characterized by detours and setbacks

User-centered healthcare IT: meaningful or meaningless?

This panel aims to discuss concepts, assumptions and visions of user- centered information technology for healthcare. It presents two opposite views on the subject. The discussion is informed by findings of three research projects evaluating the implementation of e-prescribing systems, electronic transmission of prescriptions, and electronic health records in the UK. The timeliness and perhaps urgency of such a debate are due to the incessantly increasing worldwide computerization of healthcare, concurrent to an ambiguity of the effect of IT on care processes, outcomes and user satisfaction

Covid-19: how are new uses of technology transforming healthcare?

Research is desperately needed on what works and how to embed digital tools in existing systems and processes, write Ela Klecun and Shirin Mado

THE ROLE OF CONTRADICTIONS AND NORMS IN THE DESIGN AND USE OF A TELEMEDICINE SYSTEM: A HEALTHCARE PROFESSIONALS PERSPECTIVE

Telemedicine’s potential to improve accessibility and quality of healthcare has been advocated for decades. However, its adoption has been fraught with problems. This paper applies a socio-technical approach, and specifically activity theory, to study the adoption and use of telemedicine by healthcare professionals (HCPs) in Sri Lanka. It depicts how contradictions in the initial activity sys-tem mediated by improvised telemedicine were addressed by the intended telemedicine application and how this motivated HCPs to adopt it. It also highlights the influence of social norms on the use of telemedicine. Based on the research findings this paper recommends that the designers of telemedicine need to consider: (a) identification of objects’ motivations to engage in the activity mediated by telemedicine, (b) norms and rules mediating the activity, (c) contradictions in the existing activity system, and (d) technological characteristics of the application. To stimulate its adoption, the new technology should help to address contradictions in the existing activity system, be congruent with social norms, whilst offering possibility of influencing social norms that are a source of contradictions

The Role of Contradictions and Norms in the Design and Use of Telemedicine: Healthcare Professionals’ Perspective

Telemedicine’s potential to improve healthcare’s accessibility and quality has been advocated for decades. However, its adoption has been fraught with problems. In this paper, we apply a socio-technical approach and, specifically, activity theory to study how healthcare professionals (HCPs) in Sri Lanka adopted and used telemedicine. We depict two application-based telemedicine services in Sri Lanka, one improvised and one intended. We found out how contradictions in how HCP used the improvised telemedicine facilitated their adoption of the intended telemedicine. We also highlight the influence that social norms have on how individuals use telemedicine and on the technological features of the digital platforms that enable shared economy services. Based on our findings, we recommend that telemedicine application designers need to consider: 1) subjects’ (a la activity theory) motivations to engage in the activity that telemedicine mediates, 2) the norms and rules that mediate the activity, 3) contradictions in the existing activity system, and 4) the application’s technological characteristics. To stimulate its adoption, new technology should help to address contradictions in existing activity systems, concur with social norms, and offer users the ability to influence social norms that can cause contradictions

Beyond Organizational Boundaries: The Role of Techno-Legal Configurations

In this paper, we explore how techno-legal configurations shape the evolution of an information infrastructure (II) by focusing on data as its critical components. We define techno-legal configurations as assemblages, which are technologically determined by the functionalities for data storage, processing, sharing and usage, and legally determined by the basis for data processing, such as consent, data-processing agreements or laws. To study II’s evolution we conduct an 11-year study of a regional II in Norway as electronic patient record data and patient-generated healthcare data were shared within and across hospital organizations. We show how the considerations of data as internal and external to organizations are continuously renegotiated across techno-legal configurations, which we define as harmonized space and disparate space. We contribute to the II literature by raising the importance of the law in shaping the boundaries across which data can be produced, shared and used

National electronic health records implementation: a tale with a happy ending?

Apparently similar top-down strategies led to different outcomes in Singapore and England, write Ela Klecun, Ya Zhou, Atreyi Kankanhalli, and Ralph Hibber

Evaluation as a Multi-Ontological Endeavour: A Case from the English National Program for IT in Healthcare

This paper analyzes how researchers’ different ontological and epistemological assumptions shape the process and outcomes of evaluation research. Focusing on the critical realism (CR) and social constructionism (SC) philosophical approaches, it outlines the rationale for multi-ontological evaluation and develops principles for conducting it. The paper draws from experience of evaluating a national implementation program of electronic health records in hospitals, one of the projects of the English National Programme for IT. It argues that an evaluation based on SC and one based on CR are significantly different in how they use knowledge gained in the field, and in the kind of evidence and recommendations that they can offer policy makers. The CR philosophy applied to evaluation research provides foundations from which judgments and abstractions can be presented in the form expected by the policy makers and managers who commission evaluations. In line with its ontological standing, social constructionism cannot simply or directly abstract and generalize across contexts, though it can offer other types of valuable evaluative insight. We show that, despite their differences, these two philosophical positions can, when taken together, produce jointly useful knowledge. This paper argues for the use of multi-ontological evaluation approaches and provides guidelines for undertaking such endeavors by emphasizing the need for mutual respect, dialogue, negotiation, and reflection