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Towards consistent modes for e-health implementation lessons from a telecare program’s limited success Marjolein van O

Towards consistent modes for e-health implementation lessons from a telecare program’s limited success Marjolein van Offenbeek and Albert Boonstra m.a.g.van.offenbeek@rug.nl EHMA 2008 . Telecare implementation. Introduction Research question and model Case study Telecare Outcomes

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Towards consistent modes for e-health implementation lessons from a telecare program’s limited success Marjolein van O

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  1. Towards consistent modes for e-health implementation lessons from a telecare program’s limited success Marjolein van Offenbeek and Albert Boonstra m.a.g.van.offenbeek@rug.nl EHMA 2008

  2. Telecare implementation • Introduction • Research question and model • Case study • Telecare Outcomes • Analysis Implementation • Four modes • Conclusions • Recommendations

  3. Research Question • How does the interaction among the contexts, technology and stakeholders during telecare implementation determine its use?

  4. Structurational model Telecare technology 1 2 Institutional context Institutional context Institutional context Actors 3 Actors Stakeholders 4 Implementation process telecare

  5. Case Study Context Telecom supplier Health- care insurer • Large scale programme for NL • Joint venture • Pilot: Winter ’06 – Spring ’08 • Focus: Nursing services in homecare delivery • Part of multi-services centre Provider of home care Care Clients of care families, volunteer aid

  6. Partly retrospective Longitudinal 18 months period Feedback July ‘07, March, May ’08 Otherwise no intervention Documents Interviews Clients, before & after Forms for telenurses Observation Database queries Case Study Method

  7. Telecare outcomes 11.000 clients, after selection 463 potential telecare users

  8. Telecare outcomes Use during pilot (approx. 335 users) juli aug sep okt nov dec jan feb mrt In general low use. Substantial substitution yet for few users.

  9. Tensions between pilot’s diverse goals Volume telecare Learning Substitution about telecare(cost reduction) Complementary care Better and/or more

  10. Stakeholders Telecare Pilot

  11. Four modes

  12. Telecare Implementation Conclusions • Different institutional contexts and tensions among goals prevent a consistent implementation approach • Technology seems straightforward, but requires precision because of vulnerable target groups • While ‘believers’ expect spontaneous appropriation, it needs nursing • A variety of focused services for specific target groups will be needed to render it efficient

  13. Sensemaking shared goals Explicit scope & scale (limit) Acknowledge tensions Beware of ‘conventionalist’ approach  consistent implementation mode fitting goals Alignment target groups, services, technology, organisation Extent of integration needed (both care content and organisation, incl. ICT) Telecare Implementation Recommendations

  14. Questions

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