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Telemedicine's evolutionary sociotechnical fit

Parameswaran, Vijaya
http://orcid.org/0000-0002-0984-9938
http://rave.ohiolink.edu/etdc/view?acc_num=case1712237275374992

Abstract Details

2024, Doctor of Philosophy, Case Western Reserve University, Management.
This dissertation synthesizes two studies at ambulatory clinics of an academic medical center to understand the transition from exclusive telemedicine use during the pandemic to a preference for in-person care and the varied telemedicine practices among clinical specialties and individual clinicians. I used a multi-method approach incorporating process and variance methods and multilevel analysis over time to examine telemedicine's evolution and impact on the sociotechnical (ST) system and work practices. ST systems are analyzed using a novel second-generation framework of ST fusion and punctuated change over time, combining three frameworks to emphasize their co-evolution going beyond a specific state of “fit” at a singular level. The first study utilizes a systems dynamics model to illustrate how clinical actions, accessibility, and digital options dynamically interact during aggressive telemedicine implementation, leading to different outcomes based on implementation decisions. Varying influences create feedback and feedforward loops, potentially pushing the system toward a state of constrained access and action due to the increasing shift to in-person visits post-pandemic, workflow burdens, divergent clinical actions, and the absence of necessary contextual information for care. The second study shows significant variability in telemedicine for the same diagnoses, with clinicians being the primary driver of this variability and clinicians’ perceptions of telemedicine use contingent on its ability to improve access. Time-based visualizations indicate consistent trends in low telemedicine users and declining trends among medium, high users with distinct clinician typologies based on in-group characteristics: Traditionalists (low), Pragmatists (medium), and Empiricists (high). Traditionalists prefer in-person visits for their relational aspects and professionalism, pragmatists value flexible, patient-centered care with a utilitarian telemedicine approach, and empiricists advocate care enhancements through telemedicine etiquette and technology, all calling for standardization and appropriate criteria. Different ST configurations emerge within the same activity system, differing across use groups. Convergence on in-person visits is influenced by information deficit, patient preferences, and physical exam needs. Divergence stems from infrastructure for remote monitoring, patient preference and engagement, information accessibility, and clinician's physical exam preference. Misalignment in telemedicine affordances between organizational and individual levels and issues with coherence, cognitive participation, and collective action curtails telemedicine normalization across the system.
Kalle Lyytinen (Committee Chair)
Cati Brown-Johnson (Committee Member)
David Aron (Committee Member)
Kurt Stange (Committee Member)
286 p.
Health Care Management; Information Systems; Management
telemedicine; sociotechnical systems; multi-level analysis; activity theory; affordances; normalization process theory; telemedicine variability; punctuated sociotechnical change (PSIC)

Recommended Citations

Citations

  • Parameswaran, V. (2024). Telemedicine's evolutionary sociotechnical fit [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1712237275374992

    APA Style (7th edition)

  • Parameswaran, Vijaya. Telemedicine's evolutionary sociotechnical fit. 2024. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1712237275374992.

    MLA Style (8th edition)

  • Parameswaran, Vijaya. "Telemedicine's evolutionary sociotechnical fit." Doctoral dissertation, Case Western Reserve University, 2024. http://rave.ohiolink.edu/etdc/view?acc_num=case1712237275374992

    Chicago Manual of Style (17th edition)

case1712237275374992
134
© 2024, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.