Implementation of telehomecare technology: impact on chronically ill patients, healthcare professionals and the healthcare system

Abstract

The findings in the study of diabetes patients showed that the use of DiasNet helped the patients gain an insight into their own disease as well as increasing their disease self-management skills. The project brought about changes in the tasks and duties performed by all professional groups in the diabetes team. Findings among the heart patients were as follows: Firstly, during the design and implementation phases of a telehomecare system, several types of controversies emerged as part of the inter-organisational and inter-professional agenda. These controversies involved competing claims of jurisdiction, controversies over knowledge technologies, or differences in network visions and network architecture. Secondly, the clinical decision-making and task-implementation became multidisciplinary and integrated with the implementation of telehomecare and was therefore complex in terms of the prescription and adjustment of patient medicine. Workflows between healthcare professionals across sectors changed from sequential to collective client flows. Pre-existing procedures for patient care, treatment, and responsibility were challenged. In addition, the number of tasks for the district nurses increased. Integration in the carrying out of clinical tasks increased fragmentation in the knowledge technologies in a network perspective. Thirdly, there was an impact on patients during home hospitalisation in terms of security, freedom, increased awareness of own symptoms, being ‘looked after’ but annoyed with their spouseypartner. The patients experienced a seamless cross-sector patient care process. The impact on the spouseypartner involved responsibility, nervous tension, and invasion of privacy. For the readers of the IJIC, it is of special interest to learn in the case of the diabetic patients that the use of a web-based Diabetes Insulin Advisory System gave the patients an insight into their own disease as well as increasing their disease self-management skills. The diabetes team experienced changes in their tasks and duties. Among the heart patients, we can discern emerging controversies in the design and implementation process when using telehomecare technology. These issues should be taken into account when initiating a