de Bont Antoinette, Bal Roland
Department of Health Policy and Management, Erasmus University Medical Center, Post box 1738, 3000 DR Rotterdam, the Netherlands.
BMC Med Inform Decis Mak. 2008 Oct 27;8:47. doi: 10.1186/1472-6947-8-47.
Information systems can play a key role in care innovations including task redesign and shared care. Many demonstration projects have presented evidence of clinical and cost effectiveness and high levels of patient satisfaction. Yet these same projects often fail to become part of everyday clinical routines. The aim of the paper is to gain insight into a common paradox that a technology can meet the criteria for success set out at the start of the project yet fail to become part of everyday clinical routines.
We evaluated a telecare service set up to reduce the workload of ophthalmologists. In this project, optometrists in 10 optical shops made digital images to detect patients with glaucoma which were further assessed by trained technicians in the hospital. Over a period of three years, we conducted interviews with the project team and the users about the workability of the system and its integration in practice. Beside the interviews, we analyzed record data to measure the quality of the images. We compared the qualitative accounts with these measurements.
According to our measurements, the quality of the images was at least satisfactory in 90% of the cases, i.e. the images could be used to screen the patients--reducing the workload of the ophthalmologist considerably. However, both the ophthalmologist and the optometrists became increasingly dissatisfied respectively with the perceived quality of the pictures and the perceived workload.Through a detailed analysis of how the professionals discussed the quality of the pictures, we re-constructed how the notion of quality of the images and being a good professional were constructed and linked. The IT system transformed into a quality system and, at the same time, transformed the notions of being a good professional. While a continuous dialogue about the quality of the pictures became an emblem for the quality of care, this dialogue was hindered by the system and the way the care process was structured.
To conceptualize what telemedicine does in interdisciplinary work practices, a fine-tuned analysis is needed to assess how IT systems re-shape the social relations between professional groups. Such transformations should not be exclusively attributed to the technology itself or to the professionals working with it. Instead we need to assess these technologies through an empirically grounded study of the sociotechnical functioning of telemedicine.
信息系统在护理创新（包括任务重新设计和共享护理）中可以发挥关键作用。许多示范项目都展示了临床和成本效益以及高水平患者满意度的证据。然而，这些相同的项目往往未能成为日常临床工作的一部分。本文的目的是深入了解一个常见的悖论，即一种技术可以满足项目开始时设定的成功标准，但却未能成为日常临床工作的一部分。
我们评估了一项旨在减轻眼科医生工作量的远程护理服务。在这个项目中，10家眼镜店的验光师制作数字图像以检测青光眼患者，这些图像由医院中经过培训的技术人员进一步评估。在三年的时间里，我们就系统的可操作性及其在实践中的整合情况，对项目团队和用户进行了访谈。除了访谈，我们还分析了记录数据以衡量图像质量。我们将定性描述与这些测量结果进行了比较。
根据我们的测量，在90%的病例中图像质量至少令人满意，即这些图像可用于筛查患者，从而大大减轻了眼科医生的工作量。然而，眼科医生和验光师分别对图片的感知质量和感知工作量越来越不满意。通过对专业人员如何讨论图片质量的详细分析，我们重构了图像质量概念以及成为一名优秀专业人员的概念是如何构建和联系起来的。信息技术系统转变为一个质量系统，同时也改变了成为一名优秀专业人员的概念。虽然关于图片质量的持续对话成为了护理质量的象征，但这种对话受到系统和护理流程结构方式的阻碍。
为了概念化远程医疗在跨学科工作实践中的作用，需要进行精细的分析，以评估信息技术系统如何重塑专业群体之间的社会关系。这种转变不应仅仅归因于技术本身或使用它的专业人员。相反，我们需要通过对远程医疗的社会技术功能进行基于实证的研究来评估这些技术。
