The Transformative Role of Telemedicine on Coordination: A Practice Approach

Abstract

Delivering coordinated care at a distance challenges work practices and interprofessional collaboration. Using a case study methodology, we analyzed how three occupational groups, pathologists, technologists, and surgeons, coordinate work during the deployment of a major telepathology network in Eastern Canada. The aim of this study is to determine the extent to which and how telemedicine modifies coordination practices. \ \ Transformations emerged from our in-depth case analysis around three aspects of coordination: predictability, common understanding and accountability. First, predictability relied on routines in traditional settings, but shifted to a reliance on plans and rules in a telemedicine setting. Second, common understanding of the task shifted from relying on familiarity between stakeholders to an emphasis on standards. Third, accountability became less collective and more individual and contractual in a telemedicine setting, resulting in more marked boundaries between professional groups. Finally, proximity remained a determinant of accountability in telemedicine contexts, regardless of organizational arrangements. Implications for research and practice are discussed.