Methods Inf Med 2007; 46(01): 27-35
DOI: 10.1055/s-0038-1627828
Original Articles
Schattauer GmbH

Designing and Redesigning Medical Telecare Services

A Forces-oriented Model
L.G. Gortzis
1   Telemedicine Unit, Department of Medical Physics, School of Medicine, University of Patras, Rio, Greece
› Author Affiliations
Further Information

Publication History

Received: 27 September 2005

Accepted: 07 March 2006

Publication Date:
24 January 2018 (online)

Summary

Objectives: Medical telecare services’ designing and redesigning still remains a challenging issue since it often depends on how a number of socio-technological issues are framed. This work has two key objectives; the former is to theoretically analyze the nature of a telecare environment by developing a model that reveals potential areas of analysis and the latter is to support designing and redesigning medical telecare services by formulating a strategy as well as a number of “state of the art” guidelines.

Methods: We have extended Leavitt’s diamond to develop a model capable of accurately reflecting the telecare environment building dimensions as well as their interactions. This model depends on the i) technology, ii) collaborators, iii) tasks, iv) structure, v) social forces, and the vi) procedure dimensions. Taking this model as a core element we have proposed a service designing and redesigning strategy formulating, in parallel, six scalable dimension-oriented guidelines.

Result: During the two-year period (2003-2005) an enormous amount of data was collected (by active participating in two EU projects, by conducting semistructured interviews, by performing onsite observations as well as by reviewing 78 previous projects) and classified, structuring six guidelines. These guidelines can be considered as the “state of the art” to support future services’ design and redesign.

Conclusions: This work considering the telecare environment as a multi-dimensional, operational organization has put the focus on accurate telecare services’ design and redesign. The parameters are not limited, by any means, and are drawn from experience of designing services in a variety of telecare domains. The optimal parameter combination must be chosen according to the aim of each telecare procedure. Further research is needed to determine the minimum parameters to support telecare service design.

 
  • References

  • 1 Finch T, Mort M, May C, Mair F. Telecare: perspectives on the changing role of patients and citizens. J Telemed Telecare. 2005; 11 (Suppl. 01) 51-3.
  • 2 Bouillon Y, Wendling F, Bartolomei F. Computersupported collaborative work (CSCW) in biomedical signal visualization and processing. IEEE Trans Inf Technol Biomed 1999; 3 (Suppl. 01) 28-31.
  • 3 Fujimoto M, Miyazaki K, von Tunzelmann N. Complex systems in technology and policy: telemedicine and telecare in Japan. J Telemed Telecare 2000; 6 (Suppl. 04) 187-92.
  • 4 Grau L, Colombotos J, Gorman S. Psychological morale and job satisfaction among homecare workers who care for persons with AIDS. Women Health 1992; 18 (Suppl. 01) 1-21.
  • 5 Kushniruk AW, Patel C, Patel VL, Cimino JJ. ‘Televaluation’ of clinical information systems: an integrative approach to assessing Web-based systems. Int J Med Inform 2001; 61 (Suppl. 01) 45-70.
  • 6 Staccini P, Joubert M, Quaranta JF, Fieschi D, Fieschi M. Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design. Int J Med Inform 2001; 64 2-3 129-42.
  • 7 Staccini PM, Joubert M, Quaranta JF, Fieschi M. Towards elicitation of users requirements for hospital information system: from a care process modelling technique to a web based collaborative tool. Proc AMIA Symp 2002; pp 732-6.
  • 8 Barlow J, Bayer S, Castleton B, Curry R. Meeting government objectives for telecare in moving from local implementation to mainstream services. J Telemed Telecare 2005; 11 (Suppl. 01) 49-51.
  • 9 Kinsella A. Home telecare in the United States. J Telemed Telecare 1998; 4 (Suppl. 04) 195-200.
  • 10 Poulymenopoulou M, Vassilacopoulos G. Enabling virtual emergency healthcare enterprises using Web services. Stud Health Technol Inform 2003; 95: 322-7.
  • 11 Mueller ML, Ganslandt T, Frankewitsch T, Krieglstein CF, Senninger N, Prokosch HU. Workflow analysis and evidence-based medicine: towards integration of knowledge-based functions in hospital information systems. Proc AMIA Symp 1999; 330-4.
  • 12 Winters JM, Winters JM. A telehomecare model for optimizing rehabilitation outcomes. Telemed J E Health 2000; 10 (Suppl. 02) 200-12.
  • 13 Sixsmith A, Sixsmith J. Smart care technologies: meeting whose needs?. J Telemed Telecare 2000; 6 (Suppl. 01) S190-2.
  • 14 Hanchett M. Quality of life of cancer patients receiving home infusion services. A pilot study. J Infus Nurs 2001; 24 (Suppl. 04) 244-8.
  • 15 Berg M. Medical work and the computer based patient record: a sociological perspective. Methods Inf Med 1998; 38: 294-301.
  • 16 Hartswood M, Procter R, Rouncefield M, Slack R. Making a Case in Medical Work:Implications for the Electronic Medical Record. Computer Supported Coopertive Work 2003; 12: 241-66.
  • 17 Ammenwerth E, Eichstadter R, Haux R, Pohl U, Rebel S, Ziegler S. et al. A randomized evaluation of a computer-based nursing documentation system. Methods Inf Med 2001; 40 (Suppl. 02) 61-8.
  • 18 Delone WH, Maclean ER. Information systems success: The quest for the dependent variable. Information Systems Research 1992; 3 (Suppl. 01) 60-95.
  • 19 Whyte G, Bytheway A, Edwards C. Understanding user perceptions of information systems success. Strategic Inf Syst 1997; 6: 35-68.
  • 20 Seddon PB, Staples S, Patnayakuni R, Bowtell M. Dimensions of Information Systems Success. Commun Assoc Inform Syst 1992; 2.
  • 21 Van DerMeijden MJ, Tange HJ, Troost J, Hasman A. Determinants of success of inpatient clinical information systems: a literature review. J Am Med Inform Assoc 2003; 10 (Suppl. 03) 235-43.
  • 22 Despont-Gros C, Mueller H, Lovis H. Evaluating user interactions with clinical information systems: A model based on human-computer interaction models. Journal of Biomedical Informatics 2005; 38: 244-55.
  • 23 Succi MJ, Walter ZD. Theory of user acceptance of information technologies: an examination of health care professionals. 32nd ed. Maui, Hawaii: Hawaii International Conference on System Science; 1999
  • 24 Thong JL, Hong W, Tam K. Understanding user acceptance of digital libraries: what are the roles of interface characteristics, organizational context, and individual differences?. Int J Hum Comput Stud 2005; 57 (Suppl. 03) 215-42.
  • 25 Mort M, Finch T. Principles for telemedicine and telecare: the perspective of a citizens’ panel. J Telemed Telecare 2005; 11 (Suppl. 01) 66-8.
  • 26 Lamminen H, Lugmayr A, Niiranen S, Kalli S. Proposed model of a digital video-based home telecare system. Telemed J E Health 2002; 8 (Suppl. 04) 387-94.
  • 27 Hebert MA, Korabek B. Stakeholder readiness for telehomecare: implications for implementation. Telemed J E Health 2004; 10 (Suppl. 01) 85-92.
  • 28 Brebner JA, Brebner EM, Ruddick-Bracken H. Experience-based guidelines for the implementation of telemedicine services. J Telemed Telecare 2005; 11 (Suppl. 01) 3-5.
  • 29 West VL, Milio N. Organizational and environmental factors affecting the utilization of telemedicine in rural home healthcare. Home Health Care Serv Q 2004; 23 (Suppl. 04) 49-67.
  • 30 Leavitt HJ. Applied organizational change in industry: Structural, technical, and humanistic approaches. In March J. (ed). Handbook of Organizations. Chicago: Rand McNally & Co; 1965. (March). pp 1144-70.
  • 31 Avgerou C. Information systems for development planning. International Journal of Information Management 1993; 13: 260-73.
  • 32 El Sawy OA. Redesigning Enterprise Processes for eBusiness. Boston MA: McGraw-Hill Irwin;; 2001
  • 33 Guillen S, Arredondo MT, Traver V, Valero MA, Martin S, Traganitis A. et al. User satisfaction with home telecare based on broadband communication. J Telemed Telecare 2002; 8 (Suppl. 02) 81-90.
  • 34 McCue MJ, Mazmanian PE, Hampton CL, Marks TK, Fisher EJ, Parpart F. et al. Cost-minimization analysis: A follow-up study of a telemedicine program. Telemed J 1998; 4 (Suppl. 04) 323-7.
  • 35 Jordan P. Healthcare reform: current and proposed approaches. Oncol Nurs Forum. 1994; 21 (Suppl. 07) 1215-20.
  • 36 Vandekieft G. Who decides? An ethics case consult for Terri Schiavo. Am J Hosp Palliat Care 2005; 22 (Suppl. 03) 175-7.
  • 37 Halberg F, Cornelissen G, Kumagai Y, Bingham C, Saito J, Tamura K. et al. Telehygiene system for preventive chronopharmacology in space and remote areas on earth. Chronobiologia 1994; 21 1-2 33-43.
  • 38 Tang P, Venables T. ‘Smart’ homes and telecare for independent living. J Telemed Telecare 2000; 6 (Suppl. 01) 8-14.
  • 39 Doughty K, Cameron K. Continuous assessment of the risk of falling using telecare. J Telemed Telecare 1998; 4 (Suppl. 01) 88-90.
  • 40 Rialle V, Lamy JB, Noury N, Bajolle L. Telemonitoring of patients at home: a software agent approach. Comput Methods Programs Biomed 2003; 72 (Suppl. 03) 257-68.
  • 41 Barro S, Marin R, Mira J, Paton AR. A model and a language for the fuzzy representation and handling of time. Fuzzy Sets and Systems 1994; 61: 153-75.
  • 42 Chan M, Campo E, Esteve D. Assessment of activity of elderly people using a home monitoring system. Int J Rehabil Res 2005; 28 (Suppl. 01) 69-76.
  • 43 Williams G, Doughty K, Bradley DA. Safety and risk issues in using telecare. J Telemed Telecare 2000; 6 (Suppl. 05) 249-62.
  • 44 Suchman L. Plans and SituatedActions. The Problem of Human-Machine Communication. Cambridge, MA: Cambridge University Press;; 1987
  • 45 Barlow J, Bayer S, Curry R. The design of pilot telecare projects and their integration into mainstream service delivery. J Telemed Telecare 2003; 9 (Suppl. 01) S1-3.
  • 46 Lymberis A, Olsson S. Intelligent biomedical clothing for personal health and disease management: state of the art and future vision. Telemed J E Health 2003; 9 (Suppl. 04) 379-86.
  • 47 Dan JP, Luprano J. Homecare: a telemedical application. Med Device Technol 2003; 14 (Suppl. 010) 25-8.
  • 48 Yoo T, Huh BY, Jeon H, Yun YH. Home telecare system integrated with periodic health reminder and medical record & multimedia health information. Medinfo 1998; 9 Pt 1 265-8.
  • 49 Garrod S. How groups co-ordinate their concepts and terminology: implications for medical informatics. Methods Inf Med 1998; 37: 471-6.
  • 50 Wilson K, Williams A. Visualism in community nursing: implications for telephone work with service users. Qual Health Res 2000; 10 (Suppl. 04) 507-20.
  • 51 Mortensen RA, Nielsen GH. TELENURSING: European classification of nursing practice with regard to patient problems, nursing interventions and patient outcome, including educational measures. Comput Methods Programs Biomed 1994; 45 1-2 171-3.
  • 52 McGee R, Tangalos EG. Delivery of health care to the underserved: potential contributions of telecommunications technology. Consensus conference entitled “Telemedicine and Access to Care”. Mayo Clin Proc 1994; 69 (Suppl. 012) 1131-6.
  • 53 Barnard CI. The functions of the executive. Cambridge, MA: Harvard University Press;; 1938
  • 54 Beuscart R, Bricon-Souf N, Brunetaud JM, Watbled L, Alao O, Bennani N. Homecare: the need for cooperative information systems. Medinfo 2004; 11 Pt 2 1343-7.
  • 55 Wootton R. Equipment for minor injuries telemedicine. J Telemed Telecare 1999; 5 (Suppl. 03) S14-9.
  • 56 Meresman JF, Hunkeler EM, Hargreaves WA, Kirsch AJ, Robinson P, Green A. et al. A case report: implementing a nurse telecare program for treating depression in primary care. Psychiatr Q 2003; 74 (Suppl. 01) 61-73.
  • 57 Stroetmann KA, Stroetmann VN, Westerteicher C. Implementation of TeleCare services: benefit assessment and organisational models. Stud Health Technol Inform 2003; 97: 131-41.
  • 58 Bricon-Souf N, Anceaux F, Bennani N, Dufresne E, Watbled L. A distributed coordination platform for home care: analysis, framework and prototype. Int J Med Inform. 2005 Jul 14.
  • 59 Bellazzi R, Montani S, Riva A, Stefanelli M. Webbased telemedicine systems for home-care: technical issues and experiences. Comput Methods Programs Biomed 2001; 64 (Suppl. 03) 175-87.
  • 60 Jacobs EC, Lagerlund TD, Collura TF, Burgess RC. A data interchange standard for clinical neurophysiology. Proc Annu Symp Comput Appl Med Care 1993; 813-7.
  • 61 Finkelstein J, O’Connor G, Friedmann RH. Development and implementation of the home asthma telemonitoring (hat) system to facilitate asthma self-care. Medinfo 2001; 10 (Suppl. 01) 810-4.
  • 62 Mair FS, Goldstein P, May C, Angus R, Shiels C, Hibbert D. et al. Patient and provider perspectives on home telecare: preliminary results from a randomized controlled trial. J Telemed Telecare 2005; 11 (Suppl. 01) 95-7.
  • 63 Mair F, Boland A, Angus R, Haycox A, Hibbert D, Bonner S. et al. A randomized controlled trial of home telecare. J Telemed Telecare 2002; 8 (Suppl. 02) 58-60.
  • 64 Loane MA, Bloomer SE, Corbett R, Eedy DJ, Hicks N, Lotery HE. et al. A comparison of realtime and store-and-forward teledermatology: a cost-benefit study. Br J Dermatol 2000; 143 (Suppl. 06) 1241-7.
  • 65 Brownsell SJ, Bradley DA, Bragg R, Catlin P, Carlier J. Do community alarm users want telecare?. J Telemed Telecare 2000; 6 (Suppl. 04) 199-204.
  • 66 Agrell H, Dahlberg S, Jerant AF. Patients’ perceptions regarding home telecare. Telemed J E Health 2000; 6 (Suppl. 04) 409-15.
  • 67 Robb N. Telecare acting as an “electronic grandmother” for New Brunswickers. Cmaj 1996; 154 (Suppl. 06) 903-4.
  • 68 Mahmud K, Lenz J. The personal telemedicine system. A new tool for the delivery of health care. J Telemed Telecare. 1995; 1 (Suppl. 03) 173-7.
  • 69 Maglaveras N. Citizen Health System: telehealth homecare. Stud Health Technol Inform 2003; 92: 117-25.
  • 70 Scott WR. Organizations: rational, natural, and open systems. Upper Saddle River, NJ: Prentice Hall;; 1998
  • 71 Clarke M. A reference architecture for telemonitoring. Stud Health Technol Inform 2004; 103: 381-4.
  • 72 Yamada M, Watarai H, Andou T, Sakai N. Emergency image transfer system through a mobile telephone in Japan: technical note. Neurosurgery 2003; 52 (Suppl. 04) 986-8. discussion 8-90.
  • 73 Laxminarayan S, Istepanian RS. UNWIRED E-MED: the next generation of wireless and internet telemedicine systems. IEEE Trans Inf Technol Biomed 2000; 4 (Suppl. 03) 189-93.
  • 74 Ciccarese P, Caffi E, Boiocchi L, Quaglini S, Stefanelli M. A guideline management system. Medinfo 2004; 11 Pt 1 28-32.
  • 75 Pavlopoulos S, Anagnostaki A, Koutsouris D, Lymberis A, Levene P, Reynolds M. et al. Vital signs monitoring from home with open systems. Stud Health Technol Inform 2000; 77: 1141-5.
  • 76 Short LA, Saindon EH. Telehomecare rewards and risks. Caring 1998; 17 (Suppl. 010) 36-40. 2.
  • 77 Sauermann S, Standhardt H, Gerschlager W, Lanmuller H, Alesch F. Kinematic evaluation in Parkinson’s disease using a hand-held position transducer and computerized signal analysis. Acta Neurochir (Wien) 2005; 147 (Suppl. 09) 939-45.
  • 78 Jaatinen PT, Forsstrom J, Loula P. Teleconsultations: who uses them and how?. J Telemed Telecare 2002; 8 (Suppl. 06) 319-24.
  • 79 Oakley AM. Teledermatology in New Zealand. J Cutan Med Surg 2001; 5 (Suppl. 02) 111-6.
  • 80 Frey J, Harmonosky CM, Dansky KH. Performance model for telehealth use in home health agencies. Telemed J E Health 2005; 11 (Suppl. 05) 542-50.
  • 81 Kornowski R, Zlochiver S, Botzer L, Tirosh R, Abboud S, Misan S. Validation of vital signs recorded via a new telecare system. J Telemed Telecare 2003; 9 (Suppl. 06) 328-33.
  • 82 Celler BG, Lovell NH, Chan DK. The potential impact of home telecare on clinical practice. Med J Aust 1999; 171 (Suppl. 010) 518-21.
  • 83 Tomuro K. Development of oral home telecare programme for the home-dwelling elderly: a pilot study. Gerodontology 2004; 21 (Suppl. 03) 177-80.
  • 84 Shamansky SL. Providing home care services in a for-profit environment. Nurs Clin North Am 1988; 23 (Suppl. 02) 387-98.
  • 85 Brownsell SJ, Bradley DA, Bragg R, Catling P, Carlier J. An attributable cost model for a telecare system using advanced community alarms. J Telemed Telecare 2001; 7 (Suppl. 02) 63-72.
  • 86 Wootton R, Bloomer SE, Corbett R, Eedy DJ, Hicks N, Lotery HE. et al. Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis. Bmj 2000; 320 07244 1252-6.
  • 87 Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000 (2): CD002098.
  • 88 Johnston B. Exploring the new frontier: home care gets wired. Caring 2000; 19 (Suppl. 07) 6-10.
  • 89 Kamel Boulos MN, Cai Q, Padget JA, Rushton G. Using software agents to preserve individual health data confidentiality in micro-scale geographical analyses. J Biomed Inform. 2005
  • 90 Kaluzny AD, Veney JE. Types of change and hospital planning strategies. American Journal of Health Planning 1977; 1: 13-9.
  • 91 Orlikowski WJ. Case tools as organisational change: investigating incremental and radical changes in systems development. MIS Quarterly 1993; 17: 339-40.
  • 92 Ellingsen G, Monteiro E. Mechanisms for producing a working knowledge: Enacting, orchestrating and organizing. Information and Organization 2003; 13: 203-29.
  • 93 Heinzelmann PJ, Williams CM, Lugn NE, Kvedar JC. Clinical outcomes associated with telemedicine/ telehealth. Telemed J E Health 2005; 11 (Suppl. 03) 329-47.
  • 94 Morse JM. The ramifications of perspective: how theory focuses research, data, and practice. J Wound Ostomy Continence Nurs 2005; 32 (Suppl. 02) 93-100.
  • 95 Coiera E. When conversation is better than computation. JAm Med InformAssoc 2000; 277-86.
  • 96 Berg M.. Implementing information systems in health care organizations: myths and challenges. Int J Med Inform 2001; 64: 143-56.
  • 97 Jardine I, Clough K, Navein J. The potential for telemedicine and telecare in Deptford. J Telemed Telecare 2000; 6 (Suppl. 01) S77-9.
  • 98 Despite homecare success, technology switch over inside hospital gets mixed reviews. Health Care Cost Reengineering Rep 1998; 3 (Suppl. 01) 7-9.
  • 99 Demiris G, Speedie S, Finkelstein S. A questionnaire for the assessment of patients’ impressions of the risks and benefits of home telecare. J Telemed Telecare 2000; 6 (Suppl. 05) 278-84.
  • 100 Magrabi F, Lovell NH, Henry RL, Celler BG. Designing home telecare: a case study in monitoring cystic fibrosis. Telemed J E Health 2005; 11 (Suppl. 06) 707-19.