A Contextualist Approach to Telehealth Innovations By Sunyoung Cho Abstract Healthcare is considered one of the most important social issues in the U.S. as well as in other societies with ever-increasing costs of medical service provision. The information-intensive nature of the healthcare industry and the perception of information technology (IT) as a way to ease up healthcare costs and improve quality have lead to increased use of and experiments with IT-based innovations. These activities present interesting research opportunities for IS researchers and they have led to an increasing body of knowledge on healthcare information systems. This research aims at contributing to this line of research by adopting a contextualist approach to examine the adoption, use, and further diffusion of telehealth innovations. A contextualist approach provides a particularly interesting and relevant perspective to study adoption and diffusion processes of healthcare innovations. The adopted contextualist approach is process-oriented, it applies multiple levels of analysis, and it accommodates different theoretical lenses to make sense of the two telehealth innovations under investigation. A key assumption is that innovations should be understood as ongoing processes of change, not just technologies, or isolated change events with clear boundaries. Healthcare innovations have in this view much broader connotations, including development of IT-based applications, their adoption and diffusion over time, and the interactions between many stakeholders and organizations that shape the innovation in a specific context. The contextualist approach suggested by Pettigrew is adopted as an overarching framework for multiple studies based on empirical investigation of two telehealth innovations; the main focus is on a telestroke innovation in the U.S. while a radiology innovation in Sweden serves as a complementary case. Each study is documented as an independent research publication with its own theoretical perspective and contributions. The overall contextualist approach and the related findings are then summarized across the individual studies. Telehealth innovations are particularly interesting examples of healthcare information systems. They leverage contemporary network infrastructures and interaction devices to allow provision of healthcare services, clinical information, and education over distance, thereby reducing the costs and improving the availability of medical services. The two telehealth innovations are investigated through in-depth case studies. This theses summary presents the theoretical background for the studies; it motivates and details how the qualitative case studies based on critical realist assumptions were designed and conducted; it outlines the resulting research publications; and it discusses the contributions of investigating telehealth innovations from a contextualist approach.

From September 2000 through May 2001, a team of two psychologists and two psychology graduate students (myself included) from the University of Saskatchewan delivered a variety of psychological services to a remote reserve community in northern Saskatchewan via telehealth from the Royal University Hospital in Saskatoon. Using telehealth, we provided psychoeducational information, therapy, assessments, case consultations and support services to Aboriginal health workers in this community. The present study is an evaluation of the use of telehealth in the delivery of psychological services to remote reserve communities. A semi-structured interview was employed to gain knowledge about the experiences of people involved in this telehealth project as well as the insights, thoughts and beliefs of Aboriginal and non-Aboriginal mental health workers regarding the use of telehealth with remote communities. In total, eight interviews were conducted for this study. Results indicate that although telehealth technology was seen as positive, psychology is often perceived in a negative manner by Aboriginal people. Due to this disconnection between Aboriginal people and Western psychology, psychological service provision with telehealth needs to be considered in conjunction with building relationships and trust in the community. Despite the difficulties, the results indicate that there is much that can be gained by providing psychological services to remote Aboriginal communities via telehealth.

From September 2000 through May 2001, a team of two psychologists and two psychology graduate students (myself included) from the University of Saskatchewan delivered a variety of psychological services to a remote reserve community in northern Saskatchewan via telehealth from the Royal University Hospital in Saskatoon. Using telehealth, we provided psychoeducational information, therapy, assessments, case consultations and support services to Aboriginal health workers in this community. The present study is an evaluation of the use of telehealth in the delivery of psychological services to remote reserve communities. A semi-structured interview was employed to gain knowledge about the experiences of people involved in this telehealth project as well as the insights, thoughts and beliefs of Aboriginal and non-Aboriginal mental health workers regarding the use of telehealth with remote communities. In total, eight interviews were conducted for this study. Results indicate that although telehealth technology was seen as positive, psychology is often perceived in a negative manner by Aboriginal people. Due to this disconnection between Aboriginal people and Western psychology, psychological service provision with telehealth needs to be considered in conjunction with building relationships and trust in the community. Despite the difficulties, the results indicate that there is much that can be gained by providing psychological services to remote Aboriginal communities via telehealth.

Papua New Guinea has the highest infant and maternal morbidity and mortality rates in the Western Pacific Regions and 50% of hospital admissions are from vaccine preventable diseases. About 85% of 6 million inhabitants live in rural PNG where basic services are lacking or non-existent. Difficulties such as lack of infrastructures like road network and communication, geographical barriers like big mountain ranges, large rivers and swamps, shortage of skilled health professionals and higher concentration of health workers in cities pose great challenges in delivering health services effectively across the country. Telehealth may play an important role in reaching health services to the underserved population in PNG. As part of this study, it is essential to assess the potential of telehealth to enhance the delivery of health services. Specifically, this research aims to report the knowledge, attitudes and skills towards information and communication technology of health care providers in PNG. The study used a cross sectional method of health professionals working at the time of the survey. It collected 174 questionnaires from four hospitals and used SPSS (version17.0) to analyse the data. The results showed that younger male physicians, paramedics, those with gadgets, higher educational qualifications and exposed to ICT resources possess better knowledge and skills than female, older age group and those without gadgets or under exposed to ICT. Currently, the health care professionals in general have leap frogged the technology by focusing on handheld devices such as cell phones rather than landlines. This represents scope for growth and willingness by health workers to adopt and expand telehealth in PNG.

Today, new technologies are introduced to the market every day, and constantly changing our way of living. Especially in the healthcare sector, the change process is approaching a point where doctors can benefit from the use of, for example, connected portable reading devices instead of paper-based medical record systems. The information and communication technology is promoting the evolution of a new pathway of care delivery, a paradigm shift that alters the fundamental relationship between a doctor and its patient. The concept is defined as telehealth and formulates the provision of care at a distance and provides the possibility to treat patients in their home environment instead of at the hospital. This master’s thesis has been performed on the request of Cenvigo AB, a company active in the implementation of new IT-solutions into the healthcare and eldercare. Cenvigo AB are the owners of the Parkinson’s Digital Assessment (PANDA) application. The application has been developed through research at Dalarna University and Uppsala University Hospital.  This project will initiate the launch of PANDA and also create a model for implementation of innovative IT-solutions into the healthcare systems. The model is founded in a theoretical framework and shaped with interviews related to the implementation of technology with a focus on telehealth applications. Interviews has been performed with healthcare professionals, technology developers and users to acquire a complete picture and opinions regarding the introduction of innovation in healthcare today. From the acquired information, a model is formulated as a stepwise and chronological linear process were identified key activities are included to promote a successful implementation process. The model is connected to the practice through the implementation of PANDA. In the process of implementing PANDA into the Swedish healthcare system, a collaboration with the innovation centre at Uppsala University Hospital as a healthcare organization stakeholder, has been initiated. The model consists of five phases; Assessment, Dissemination, Adoption, Implementation and Continuation. The phases are seen as transitional steps in the innovation process, critical barriers to overcome towards a successfully implementation in a mainstream routine setting. Each phase includes a number of activities and to achieve progression in each phase, these activities must be performed in order to advance to the next phase. In the case of PANDA, the process of progression has passed assessment and are currently involved in activities related to the dissemination phase. The purpose of the model is to be used both for existing and future applications in the segment of medicine technology sector. The structure of the model is designed to promote a co-design or a common value principle of development and practice regarding an innovation. By connecting actors from both technology and healthcare in close relationships the actual needs of healthcare professionals could more effectively be identified and developed into a solution, a result from the amplification of a two-way engagement. The outmost aim is to serve as a catalysing factor, complementing the implementation models of healthcare in Sweden today. Through this study, a need for facilitating the implementation process of new technology into the healthcare systems has been identified. This model offers the necessary input that many technology companies lack. The recommendation to Cenvigo AB is to continue to develop the model during the last step in the process of launching PANDA, and parallel use this model as a business model mainly for technology start-ups and larger foreign companies that has not yet established pathways into the Swedish healthcare system. / <p>TVE 14 036</p>

An aging population is one common challenge faced by many developed countries including Australia. The Australian government has realised that the existing healthcare system must be improved to provide better support longer-term for the healthcare needs of this population. This research examines one such opportunity by suggesting a reform on how the care needs of residents living in Australian residential aged care facilities (RACF) are assessed. A recent study has shown that the current assessment system, known as the Residential Classification Scale (RCS), is subjected to high administrative procedural overhead costs and significant deviations in assessment results. This thesis documents a technical feasibility study of a novel method aimed to solve issues related to the time demands and subjectivity of the RCS through the design and implementation of a Wireless Sensor Network (WSN). This WSN is engineered to unobtrusively collect data from wireless sensor nodes either embedded in the RACF environment or attached to the resident??s body. The collected data can be potentially used to provide automatic and accurate care level assessments for the resident. The methodology of preparing and conducting the experiments to prove the hypotheses is justified and described, including the experimental instruments and procedures involved. The results show that this WSN surpasses similar research systems in terms of its application scale, the number and types of sensor nodes involved and the complexity of its hardware and firmware architectures. The major contributions of this thesis are: ?? The WSN developed satisfies certain technical requirements to be declared fit for use in a mock Australian RACF. ?? The WSN provides high sensor detection accuracies (between 88% and 100%), superior location tracking capability (94.75%) and activities of daily living inference capability over similar studies. Opportunities for further improvements of this WSN include: ?? Fine tuning the detection accuracy of Passive Infra-red (PIR) motion sensors. ?? Minimising the down time of the sensor nodes due to firmware memory leak. ?? An extra location tracking mechanism to improve location accuracy determination.

An aging population is one common challenge faced by many developed countries including Australia. The Australian government has realised that the existing healthcare system must be improved to provide better support longer-term for the healthcare needs of this population. This research examines one such opportunity by suggesting a reform on how the care needs of residents living in Australian residential aged care facilities (RACF) are assessed. A recent study has shown that the current assessment system, known as the Residential Classification Scale (RCS), is subjected to high administrative procedural overhead costs and significant deviations in assessment results. This thesis documents a technical feasibility study of a novel method aimed to solve issues related to the time demands and subjectivity of the RCS through the design and implementation of a Wireless Sensor Network (WSN). This WSN is engineered to unobtrusively collect data from wireless sensor nodes either embedded in the RACF environment or attached to the resident??s body. The collected data can be potentially used to provide automatic and accurate care level assessments for the resident. The methodology of preparing and conducting the experiments to prove the hypotheses is justified and described, including the experimental instruments and procedures involved. The results show that this WSN surpasses similar research systems in terms of its application scale, the number and types of sensor nodes involved and the complexity of its hardware and firmware architectures. The major contributions of this thesis are: ?? The WSN developed satisfies certain technical requirements to be declared fit for use in a mock Australian RACF. ?? The WSN provides high sensor detection accuracies (between 88% and 100%), superior location tracking capability (94.75%) and activities of daily living inference capability over similar studies. Opportunities for further improvements of this WSN include: ?? Fine tuning the detection accuracy of Passive Infra-red (PIR) motion sensors. ?? Minimising the down time of the sensor nodes due to firmware memory leak. ?? An extra location tracking mechanism to improve location accuracy determination.

Os profissionais da comunicação frequentemente buscam atendimento fonoaudiológico para a suavização de características desprestigiadas em sua fala. Estudos têm apontado a Telessaúde como ferramenta complementar ou alternativa no cuidado das pessoas. Entretanto, é necessário investigar o impacto do uso destas tecnologias na prática clínica e avaliar se as orientações dadas a distância são tão efetivas quanto as orientações presenciais. O objetivo deste estudo é verificar a eficácia de uma oficina na modalidade a distância para suavização de sotaque do arquifonema {R} quando realizado como tepe retroflexo e comparar a abordagem a distância com a presencial. Foram desenvolvidas duas oficinas: Oficina para Suavização de Sotaque a Distância, disponibilizada na Plataforma Virtual Tidia-Ae da Universidade de São Paulo e a Oficina para Suavização de Sotaque Presencial, realizada no Anfiteatro de Fonoaudiologia da Faculdade de Odontologia de Bauru da Universidade de São Paulo. Ambas as oficinas foram compostas por dez módulos contendo atividades teóricas e atividades práticas. Participaram das oficinas 23 estudantes/profissionais de Locução/Jornalismo/Rádio e TV, de ambos os sexos e média de idade de 26,87 anos (DP = 7,37). Para avaliação das oficinas, todos os participantes tiveram suas vozes gravadas e responderam a questionários antes e ao final das oficinas. Os resultados do presente estudo indicaram que os participantes de ambas as oficinas obtiveram suavização de sotaque significante após sua participação nas oficinas e que não houve diferença significante entre as duas abordagens de oficina. / The Communication Professionals often seek speech therapy for smoothing discredited characteristics in speech. Studies have pointed Telehealth as a complementary or alternative tool to care people. However, it is necessary investigate the impact of using these technologies in clinical practice and assess whether the guidelines given in telepractice are as effective as face-toface guidance. This study aims verify the effectiveness of a e-learning workshop for smoothing accent at archiphoneme {R} when pronounced as retroflex flap and compare telepractice and face-to-face approach. Two workshops were developed: the \"E-learning Workshop to Smooth Accent\" available for participants in Tidia-Ae Virtual Platform of the University of São Paulo, and the \"Face-to-Face Workshop to Smooth Accent\" held at the Speech Pathologys Amphitheatre at Faculty of Dentistry of Bauru, University of São Paulo. Participated 23 students or professional media workers, regardless of gender and with 26,87 average age (SD = 7,37). Both workshops were composed of ten modules containing theoretical and practical activities. For workshops evaluation, all participants had their voices recorded and they answered questionnaires before and after the workshops. The results of this study pointed significant smoothing accent for participants after their participation in both workshops, and there was no statistical difference between the telepractice and face-to-face approach.

Submitted by Daniele Santos (danielesantos.htl@gmail.com) on 2017-02-21T20:29:41Z No. of bitstreams: 1 Gus Davidson.pdf: 970488 bytes, checksum: 476e7012037f6f72d871810a4fdaf8f5 (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2017-02-23T16:38:01Z (GMT) No. of bitstreams: 1 Gus Davidson.pdf: 970488 bytes, checksum: 476e7012037f6f72d871810a4fdaf8f5 (MD5) / Made available in DSpace on 2017-02-24T12:39:36Z (GMT). No. of bitstreams: 1 Gus Davidson.pdf: 970488 bytes, checksum: 476e7012037f6f72d871810a4fdaf8f5 (MD5) Previous issue date: 2016-11-10 / Health care is a rapidly evolving industry with new technologies constantly entering the marketplace. Supply for quality care has to continuously catch up to demand. The United States’ primary care system is at a crossroads, as patients rightly demand the best in health care costs, access, and quality. How will the industry continue to deliver high quality of care with our nation’s increasing demands? What technologies can be best utilized when caring for our aging population? This thesis is built around key sections that address our country’s impending physician shortage and how our health care system can combat growing demand with better processes and technologies. First, this thesis will examine physician shortages in America and what opportunities are available to address the problem. Existing health care research has found that advanced practice providers improve the costs, access, and quality of care as a solution to the impending shortage. This review will also assess the effectiveness of advanced care providers and health systems using telehealth, and how technology can alleviate the primary care physician shortage. An analysis was also conducted to document the United States’ current ratio of physician to patients in each state, which shows that adding advanced primary care providers and telehealth services can narrow the gap between supply and demand in most states. Second, this thesis will analyze the impact of telehealth in the U.S. health care system. A literature review of telehealth’s definition and history will give a foundation of how the technology has already changed how Americans access care, especially in rural areas. This thesis is proposing that advance practice providers can deliver primary care services using telehealth. Through the review of studies and literature, in addition to interviews with industry experts, it is suggested that there is a lack of concrete evidence with which to fully assess the economic impact of telehealth. Two of the most common economic evaluation methods are cost-utility analysis (CUA) and cost-effectiveness analysis (CEA). The main x objective of CUA, which is used especially in health technology assessment, is to estimate the ratio between the cost of a health-related intervention and the benefit it produces in terms of the number of years lived in full health by the users. In health technology assessments, the benefits are usually expressed in quality adjusted life years.1

O Brasil possui uma distribuição heterogênea de infraestrutura no setor da saúde, com diferentes níveis de qualificação profissional. Isto leva a variações na qualidade dos serviços de saúde no país. O cenário de Atenção Primária à Saúde (APS) possui um contingente de profissionais que necessita de ações de aperfeiçoamento profissional contínuas. Com esta necessidade de fortalecimento na política de formação de pessoal, a Organização Pan Americana de Saúde (OPAS) buscou a difusão da proposta de Educação Permanente em Saúde (EPS), objetivando alcançar um maior desenvolvimento dos sistemas de saúde na região. Este trabalho investigou como a Mineração Textual pode contribuir no processo de resposta de teleconsultorias a profissionais solicitantes. Aprimorando a recuperação de informação dentro da Plataforma de Telessaúde do Ministério da Saúde, para auxiliar o teleconsultor no seu processo de resposta, avaliou-se as possibilidades de melhoria das informações ofertadas, além de otimização do tempo de respostas. O minerador Sobek foi utilizado para extrair conceitos de um conjunto de solicitações de profissionais presentes na Plataforma. Um ambiente foi construído para armazenar estas minerações e disponibilizar uma pesquisa de solicitações que pudesse facilitar o processo de resposta de teleconsultoria. Foi realizado um estudo com 37 profissionais, que receberam teleconsultorias a serem respondidas no novo ambiente. Após realizarem este processo, os teleconsultores responderam a um questionário com questões abertas e fechadas que buscavam aferir possíveis benefícios das funcionalidades disponibilizadas quanto à precisão das respostas, autonomia e resolutividade dos profissionais solicitantes. Os resultados permitiram concluir que a lista de tópicos extraída pelo minerador Sobek, apresentada no ambiente de avaliação construído, pôde auxiliar na localização de informações pertinentes para a construção de respostas, na aceleração do processo de resposta e na construção de respostas mais informativas e precisas. Os teleconsultores que participaram da pesquisa também consideraram que a consulta de solicitações e respostas prévias pode contribuir na educação permanente de profissionais de saúde. As novas funções introduzidas no ambiente desenvolvido também foram consideradas como incrementos positivos no atual mecanismo de pesquisas da Plataforma de Telessaúde do Ministério da Saúde por 83% dos participantes, motivando estudos futuros sobre o emprego da mineração textual no contexto da Telessaúde. / Brazil has a clear heterogeneous infrastructure distribution, with different levels of professional qualification. This leads to variations in the quality of health services in the country. The Brazilian situation on Primary Health Care includes a profile of Family Health Teams that generally did not receive specialist qualification in terms of Primary Care, constituting a contingent of professionals who needs professional development activities. Because of such need for change in staff training policies, the Pan American Health Organization (PAHO) aimed for the diffusion of Permanent Health Education, trying to obtain adequate development of health services in the region. The main goal of this study has been to investigate how Text Mining could contribute to the teleconsulting process. Aiming to help the teleconsultants in their answering process, information retrieval inside the Health Ministry Telehealth Platform was enhanced. Then, the possibilities obtained through this enhancement were evaluated, such as better information provided and shorter answering time. Sobek Mining Tool was used extract a set of concepts of requests present in the platform. An evaluation environment was built to implement the proposed teleconsultation answering process. A study with 37 teleconsultant professionals was conducted, in which the participants solved two consultations. After that, they answered a questionnaire with open and closed questions, expressing their view about the answering process supported by the text mining tool. The evaluation covered aspects such as precision, autonomy and ability to solve the problem. Results showed that the list of concepts mined by Sobek, presented in the evaluation environment, helped in the search for relevant information related to the requests, speeding up the response process to build better and more accurate answers. The teleconsultants involved in this evaluation also considered how the search for previous requests and answers could contribute in continuing professional education. The new features presented in the evaluation environment were considered positive (83% of the participants) when compared with the current search mechanism present in the Health Ministry Telehealth Platform, encouraging future studies about text mining in the context of Telehealth. / Teleducação