Outpatient consultations form a large part of the healthcare of patients at tertiary hospitals, both as a precursor to in-patient treatment and for the management of on-going health conditions or long-term rehabilitation and monitoring after treatment. These outpatient consultations are generally conducted at the hospitals, most often located in large cities. Patients who live outside these cities face extensive travel to attend these consultations, placing a burden on themselves and on their families or carers. An ability of a tertiary hospital to deliver outpatient consultations in a telehealth mode to regional or remote locations closer to the patients homes would potentially relieve much of this burden of travel.
Tertiary healthcare is highly complex. It can involve multiple clinicians, can require long time periods for its completion and often includes the patients and their families in the management of the healthcare situation. Outpatient consultations typically involve high levels of interpersonal discussion supported by access to data about the patient. Telehealth methods of delivering these outpatient consultations will be very demanding on the network connection between hospital and remote telehealth nodes. The next generation of Internet or intranet, often referred to as broadband, will have the capacity to deliver multiple high-quality, low-latency video streams and to provide shared access to large data sets. The prospective match of the capabilities of broadband networks and the needs of tertiary-level telehealth opens the possibility of effective, tertiary-level outpatient consultations in a telehealth mode of delivery.
In this thesis I use a case-study-based approach to evaluate the development and pilot trial of a broadband telehealth system in a tertiary paediatric context. I use the data from these case studies to explore the way that a human-centred approach can be used to evaluate outpatient telehealth trials at a tertiary level of healthcare. My results show that human-centred evaluation for this level of telehealth must take a broad approach; that the telehealth activities must take place in a realistic setting; that qualitative and quantitative responses from participants must be complemented by observational data; that data must be gathered from all the participants; and that their competence to give meaningful responses must be recognised and their multiple, and possibly differing, points of view must be taken into account. Finally, my results show that the researchers must take into account the wider clinical and hospital contexts and in particular the participants view of these contexts, when interpreting evaluation data.
My overall prediction is that telehealth applications for tertiary-level outpatient consultations will have important, transient phases in their development, and that a human-centred evaluation approach is the appropriate way to evaluate telehealth applications during these phases. These transient phases are not reported in conventional telehealth literature but my analysis of my case studies suggests that they are central to this class of tertiary level telehealth delivery.
| Identifer | oai:union.ndltd.org:ADTP/278976 |
| Date | January 2010 |
| Creators | Stevenson, Duncan Roderick, duncan.stevenson@anu.edu.au |
| Publisher | The Australian National University. Faculty of Engineering and Information Technology |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://www.anu.edu.au/legal/copyrit.html), Copyright Duncan Roderick Stevenson |
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