Considering the Artifact Ecology when Supporting the Evolution of Practices - Analyzing the Parallel Journeys of Two Teleconsultation Software in a General Hospital

Abstract

The growing use of teleconsultation, especially since the start of the Covid-19 pandemic, changes physicians' work at the hospital. In this paper, we set out to study how physicians have integrated teleconsultation into their healthcare practices. Moreover, we are interested in how teleconsultation software contributes to developing new medical practices and how the design of teleconsultation software can better support them. Based on 16 months of fieldwork in a general hospital that offers two different teleconsultation software, we have investigated teleconsultation practices through interviews and observations involving ten physicians doing teleconsultation and a telemedicine secretary. Unlike the existing informal remote care by phone, we observe that teleconsultation supports new formal healthcare practices, particularly for patient care management and inter-organizational cooperation. While analyzing the integration of teleconsultation in physicians' practices, we highlight that both pieces of software do not support those practices on equal terms according to their design. We argue that teleconsultation software design can limit the spread of these new healthcare practices and that the artifact ecology of physicians should be considered during the design process.