The Emergence and Unfolding of Telemonitoring Practices in Different Healthcare Organizations.

Jannie Christensen

doi:10.3390/ijerph15010061

Abstract

Telemonitoring, a sub-category of telemedicine, is promoted as a solution to meet the challenges in Western healthcare systems in terms of an increasing population of people with chronic conditions and fragmentation issues. Recent findings from large-scale telemonitoring programs reveal that these promises are difficult to meet in complex real-life settings which may be explained by concentrating on the practices that emerge when telemonitoring is used to treat patients with chronic conditions. This paper explores the emergence and unfolding of telemonitoring practices in relation to a large-scale, inter-organizational home telemonitoring program which involved 5 local health centers, 10 district nurse units, four hospitals, and 225 general practice clinics in Denmark. Twenty-eight interviews and 28 h of observations of health professionals and administrative staff were conducted over a 12-month period from 2014 to 2015. This study’s findings reveal how telemonitoring practices emerged and unfolded differently among various healthcare organizations. This study suggests that the emergence and unfolding of novel practices is the result of complex interplay between existing work practices, alterations of core tasks, inscriptions in the technology, and the power to either adopt or ignore such novel practices. The study enhances our understanding of how novel technology like telemonitoring impacts various types of healthcare organizations when implemented in a complex inter-organizational context.

Highlights

Most Western healthcare systems face challenges in regard to changing demographics, with an increased population of elderly people with chronic conditions, higher demands about patient-centeredness and quality of care, and restricted resources
The local project managers who were responsible for implementing the program in their local organization helped to identify the health professionals who were formally assigned to work with telemonitoring and they helped to establish a contact to these health professionals, except from the general practitioners (GPs) who were recruited through a direct contact
Telemonitoring involved new forms of activities related to the core tasks in the program, but it required another way of understanding what constitutes good clinical practice in regard to assessment of the patients’ conditions; identification of exacerbations; initiating, adjusting, and terminating treatment; and more relational aspects, such as interpersonal relations with the patients and more extensive collaboration with other health professionals

Summary

Introduction

Most Western healthcare systems face challenges in regard to changing demographics, with an increased population of elderly people with chronic conditions, higher demands about patient-centeredness and quality of care, and restricted resources. Telemonitoring, which is a subset of telemedicine technology, is articulated as one of the answers to these challenges, since telemonitoring is believed to be an innovative way to deliver care efficiently in a way that further supports patient-centered care (see, e.g., [1]). This belief has led to extensive experimentation with various forms of home telemonitoring services throughout the world (see [2]). Prior studies have shown how the uptake of new technologies and innovations such as telemonitoring (and telemedicine more broadly) requires their alignment with existing clinical practices found that usage of telemonitoring differed among medical specialities An explanation of this diminished effectiveness in large-scale projects can be found by focusing on the emergence of telemonitoring practices and how these practices are (dis)connected to the existing practices of the various health professionals responsible for delivering the telemonitoring services.

Methods

Results

Discussion

Conclusion