Department of Sociology and Social Work, Center of Organization, Management and Administration, Aalborg University, Kroghstraede 7, 9220 Aalborg, Denmark.
Int J Environ Res Public Health. 2018 Jan 3;15(1):61. doi: 10.3390/ijerph15010061.
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.
远程监测作为远程医疗的一个分支，被宣传为解决西方医疗保健系统面临的挑战的一种解决方案，这些挑战包括慢性病患者人数增加和碎片化问题。最近在大规模远程监测项目中发现，这些承诺在复杂的现实环境中很难实现，这可能是由于专注于远程监测用于治疗慢性病患者时出现的实践。本文探讨了远程监测实践的出现和展开，涉及丹麦的一个大规模的跨组织家庭远程监测计划，该计划涉及 5 个当地健康中心、10 个地区护士单位、4 家医院和 225 个普通诊所。2014 年至 2015 年期间，对卫生专业人员和行政人员进行了 28 次访谈和 28 小时的观察。本研究的结果揭示了远程监测实践在不同的医疗保健组织中是如何不同地出现和展开的。本研究表明，新实践的出现和展开是现有工作实践的复杂相互作用、核心任务的改变、技术的铭刻以及采用或忽略这些新实践的能力的结果。该研究增进了我们对当远程监测等新技术在复杂的跨组织环境中实施时，如何影响各种类型的医疗保健组织的理解。
