Activity Theory Analysis of the Drivers of Telemedicine: A Mixed Methods Study

Abstract

Telemedicine has a rich history, and recent advancements in communication technology have expanded its potential. Despite COVID-19 pandemic-related surges, telemedicine has returned to pre-pandemic levels in some settings, highlighting the need to understand the drivers and contextual factors. Previous studies using linear prediction models and single-method approaches fail to capture the complexities and nonlinear relationships among clinicians, patients, technology, and clinical tasks. We employ a concurrent mixed-method approach, combining quantitative analysis of electronic medical record (EMR) data and Activity Theory analysis of clinician interviews to investigate telemedicine drivers in primary care clinics. Findings confirm the significant role of clinicians and challenge assumptions of resistance to technology. Clinicians exhibit Plasticity and Elasticity by balancing roles, adjusting routines, and prioritizing patients' clinical and social needs to accommodate telemedicine. It informs technological design interventions to enhance telemedicine and clinical care, including data transfer, virtual touch, and sociodemographic integration into EMR.