The term telemedicine is broadly defined as the use of information and
communication technology to deliver health care at a distance. However, the concept of
‘telemedicine’ still lacks consensus both in the literature and in practice. Generation of
telemedicine knowledge and evidence for clinical practice is still controversial within the
telemedicine scholarship and among decision-makers as telemedicine objectives remain
ill-defined and outcomes vary in time. In Ontario, despite the fast pace of information and
communication technology change and the increased interest in its health applications,
telemedicine is not a mainstream model of care delivery within the medical system.
This study empirically investigates the social construction of telemedicine
technologies to understand how telemedicine expectations shaped telemedicine in Ontario
(Canada) from 1993 to 2017. Drawing from the Social Construction of Technologies
framework (SCOT) and historical narrative analytical techniques, it identifies the shared
understandings of what telemedicine is (and is not) and what role telemedicine plays in
the health care system. I used grounded theory methodology to develop a narrative theory
of how the future of telemedicine in Ontario has been constructed over the last 24 years
from national newspaper articles, stakeholder documents, service provider websites, and
semi-structured interviews with relevant telemedicine stakeholders. Findings show that
the development of telemedicine narratives in Ontario is a multi-storied process of
conflicting and overlapping visions and expectations among stakeholders and interests.
Telemedicine expectations focus mostly on the process of innovation, the provideroriented
approach to telemedicine, and the advantages and risks of adopting consumercontrolled
telemedicine in a publicly insured health care system. The telemedicine visions
result fragmented among different stakeholders and practices, overall inhibiting
telemedicine’s future agenda. These findings intend to help researchers, policy makers,
private vendors, and health care providers to create a vision of telemedicine that
accommodates competing expectations among the clinical, technical, political, and
commercial worlds. / Thesis / Doctor of Science (PhD) / Telemedicine delivers health care at a distance by letting doctors talk to patients
or other doctors via video, email, or text messages. However, as simple as this idea is,
researchers, physicians, policy-makers, and entrepreneurs have speculative, overlapping,
and conflicting views about what it should be. These differing views create ambiguity and
often confuse the aims of health policy decision-makers and end-users limiting
telemedicine’s development.
I intend to clarify telemedicine’s shared and diverging understandings of what
telemedicine should be by analyzing how stakeholders in Ontario have told and tell
stories about telemedicine’s future over the last three decades. I view stories of the
technology’s future as persuasive policy arguments that stakeholders adopt to shape and
use telemedicine according to their visions and goals. These findings will help
researchers, policy-makers, doctors, and businesspeople understand what telemedicine is
(and is not) to help them define policies and guidelines for its adoption and
implementation.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/23046 |
| Date | January 2018 |
| Creators | Brundisini, Francesca |
| Contributors | Giacomini, Mita, Egan, Michael, Kapiriri, Lydia, Kohler, Jillian, Health Policy |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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