Ekeland Anne Granstrøm, Hansen Anne Helen, Bergmo Trine Strand
Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromsø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
J Med Internet Res. 2018 Oct 25;20(10):e282. doi: 10.2196/jmir.8497.
Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted, and those used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of electronic health (eHealth) identified 51 unique definitions. In addition, the "10 E's of eHealth" was developed. In 2015, the question "What Is eHealth: Time for an Update?" was posed.
Considering videoconferencing as eHealth, the objective of the paper is twofold: to demonstrate and cluster (different) clinical videoconferencing practices and their situated implications and to suggest interpretive concepts that apply to all clusters and contribute to generative learning of eHealth by discussing the concepts as add-ons to existing descriptions of eHealth in the "10 E's of eHealth."
We performed a literature search via the National Center for Biotechnology Information, encompassing PubMed and PubMedCentral, for quality reviews and primary studies. We used the terms "videoconferencing" and "clinical practices." The selection process was based upon clearly defined criteria. We used an electronic form to extract data. The analysis was inspired by critical and realist review types, grounded theory, and qualitative meta-synthesis.
The search returned 354 reviews and primary studies. This paper considered the primary studies, and 16 were included. We identified the following 4 broad clusters: videoconferencing as a controlled technological intervention within existing health care organizations for expert advice, controlled mixed interventions with experimental organizational arrangements, videoconferencing as an emerging technosocial service involving dialogue and empowerment of patients, and videoconferencing as a controlled intervention to improve administrative efficiency. The analysis across the clusters resulted in a proposal to add the following 4 D's to the existing 10 E's: (inter)-dependent, differentiated across services and along temporal lines, dynamic in terms of including novel elements for meeting incremental needs, and demanding in terms of making new challenges and dual results visible and needing fresh resources to meet those challenges. For a normative discussion about what eHealth should be according to authors' conclusions, results suggested ethical, in that users interests should be respected, and not harmful in terms of increasing symptom burden.
Services were enacted as dynamic, differentiated concerning content and considerations of quality and adaptive along temporal lines. They were made to work from an ongoing demand for fresh resources, making them interdependent. The 4 D's-Dynamic, Differentiated, Demanding, and (inter) Dependent-serve as pragmatic add-ons to the "10 E's of eHealth." Questions concerning outcome of specified balances between standardization and customization in clinical settings should be addressed in future research along with the emerging dual character of outcome: services being considered both "good" and "bad."
早期的研究描述了视频会议技术、外围设备、组织模式、人际关系、目的、目标和角色具有通用性、多面性，且在不同临床实践中的使用方式各异。目前尚缺乏与服务特定特征相关的益处和挑战方面的知识。2005年对已发表的电子健康（eHealth）定义进行的系统综述确定了51个独特的定义。此外，还提出了“电子健康的10个E”。2015年，有人提出问题“什么是电子健康：是时候更新了？”
将视频会议视为电子健康，本文的目的有两个：展示并聚类（不同的）临床视频会议实践及其实际影响，并通过将这些概念作为对“电子健康的10个E”中现有电子健康描述的补充进行讨论，提出适用于所有聚类并有助于电子健康生成性学习的解释性概念。
我们通过美国国立医学图书馆的生物技术信息中心进行文献检索，涵盖PubMed和PubMedCentral，以获取高质量综述和原始研究。我们使用了“视频会议”和“临床实践”等术语。选择过程基于明确界定的标准。我们使用电子表格提取数据。分析的灵感来自批判性和现实主义综述类型、扎根理论以及定性元综合。
检索返回了354篇综述和原始研究。本文考虑了原始研究，纳入了16篇。我们确定了以下4个广泛的聚类：视频会议作为现有医疗保健组织内用于专家咨询的受控技术干预、具有实验性组织安排的受控混合干预、作为涉及患者对话和赋权的新兴技术社会服务的视频会议，以及作为提高行政效率的受控干预的视频会议。对各聚类的分析结果建议在现有的10个E基础上增加以下4个D：相互依赖的、在服务之间以及沿时间线有所区分的、在纳入满足增量需求的新元素方面具有动态性的、在使新挑战和双重结果可见并需要新资源来应对这些挑战方面具有需求性的。关于根据作者结论电子健康应该是什么的规范性讨论，结果表明应符合伦理，即应尊重用户利益，且在增加症状负担方面无害。
服务被视为动态的，在内容、质量考量方面存在差异，并沿时间线具有适应性。它们因对新资源的持续需求而相互依存。这4个D——动态的、有差异的、有需求的和相互依赖的——是对“电子健康的10个E”的实用补充。未来的研究应解决临床环境中标准化与定制化之间特定平衡的结果问题，以及结果的新兴双重特征：服务既被视为“好”的，也被视为“坏”的。
