Interaction as a condition for implementation and use of telemedicine services at North Norwegian general practices
During 2003, 94 general practices were offered telemedicine equipment for transmission of dermatology and plastic surgery images to specialists at the University Hospital. By the end of 2004, 22 of the offices had utilized the services. The situations for the general practices seemed to be equal, so it was important to understand why some had used the services, while the majority of offices had not. We conducted a qualitative inquiry at 4 of the user offices, where altogether 80 % of all use occurred, and at 4 comparable offices which had not used the services.
Our hypothesis was that use would be created as a result of interaction between interested GP’s, technology and grounded needs at the GP offices. If one or more of these components lacked, use would not occur.
During 2003, 94 medical offices in North Norway received basic equipment for teledermatology and "ent". Statistics for use in 2004 indicated that 22 offices had utilised the services to a variable degree. Mainly the dermatology equipment was used. The offices were commensurable concerning technology and economic and legal regulations. Common explanations concerning facilitators and restrictions were thus not adequate to explain why some of them used the equipment, and a majority did not.
To understand why some offices used the equipment, while other ones did not. We wanted to unveil sustainable local strategies for successful use, as well as other local preferences and practices.
Explorations on how different "players": personal, professional, technological and regulatory ones participated in the development. Based upon statistics for use, a strategic sample of the four top users were selected for in-depth interviews. These offices represented approximately 80 % of the total use. Four non-users with similar patient populations, numbers of doctors and health care workers, and rural/urban characteristics, were also selected. We interviewed doctors, nurses and health secretaries who had been involved in the process of equipping the offices and of implementing and using the telemedicine services.
By September 2005, some very interesting preliminary trends were emerging from the interview data. It seems that relatively individualised practices are played out in user offices as well as with the non-users. Specific personal resourses, local conditions and perceptions of the technologies and tasks at each medical office, co-participated through networks of relations in constructing strategies for use, versus other local strategies. Hence the notion "Networks of use". The results will be presented in a planned article which will be submitted for publication in a Norwegian medical journal. An English summary will be available.
Northern Norway Regional Health Authority, Telemedicine Research Programme