Navigating the evolving telemedicine landscape: Adaptations and outcomes

Guide(s)

Bandi, Rajendra K

Department

Information Systems

Area

Information Systems

University

Indian Institute of Management Bangalore

Place

Bangalore

Publication Date

3-31-2025

Year Awarded

March 2025

Year Completed

March 2025

Year Registered

June 2019

Abstract

More than half of the world's population lacks access to healthcare because of disparities in the distribution of healthcare infrastructure and professionals within and between nations. Telemedicine, broadly defined as "remote diagnosis and treatment of patients using telecommunications technology" (Delana et al., 2023), offers a potential solution for providing equitable, affordable, and efficient healthcare because of its ability to virtualize care (Ayabakan et al., 2023). Many governments and the private sector have invested heavily in telemedicine adoption, especially after the COVID-19 pandemic. According to Grand View Research, the global telemedicine market is expected to reach $380 billion by 2030. Advancements in ICT and healthcare technologies have transformed telemedicine into innovative forms, such as remote patient monitoring, tele-ICUs, and home care services that enable continuous patient monitoring and timely interventions. Care delivery has shifted from hospitals to patients' homes, involving diverse care providers - doctors, nurses, technicians, healthcare workers, and care receivers - patients & their caretakers. Telemedicine is no longer a monolithic system used for physician-to-physician interactions on hospital premises, requiring a fresh research outlook.The interplay between heterogeneous actors, advanced technologies, and medical procedures and treatment strategies to address various patient needs adds to the complexity of telemedicine (Trupia et al., 2021). Low ICT skills, low health literacy, and lack of infrastructure in developing countries exacerbate the complexity. As a result, users adjust or adapt their work practices and technologies to achieve their goals (Schmitz et al. 2016). Adaptations are double-edged in nature; they are beneficial in facilitating task completion and enabling information systems (IS) use for individuals and organizations but can also lead to negative outcomes such as inefficient IS usage and suboptimal task performance (Lyng et al., 2021). Deviating from prescribed routines can jeopardize patient care and safety in clinical settings. An understanding of adaptations in telemedicine is crucial, which this thesis aims to address.Patient-physician encounters are essential for accurate diagnosis and treatment in clinical settings. Physicians gather patient health information in different ways, such as patient interactions, clinical history, physical examinations, and investigation reports for assessing diseases and providing care during these encounters (Balogh et al., 2015). Different disease conditions have different information needs. In telemedicine, the interactions occur through technology-mediated interactions, i.e.,tele consultations, between remote specialists and patients or physicians. The absence of direct interactions and physical examination in teleconsultations can affect the sensory dimensions of the diagnosis process and patient-physician relationships, with significant implications on how healthcare professionals and patients experience telemedicine and its efficacy for healthcare outcomes. The senses of touching, feeling, and smelling are difficult to reproduce electronically, thereby limiting the sensory engagement between remote physicians and patients during teleconsultations. Low sensory engagement can restrict the ability to gather complete information for a proper diagnosis, potentially leading to poor clinical judgment and diagnostic mistakes. Prior studies note that diagnostic errors contribute to approximately 10% of patient deaths and adverse hospital outcomes (Cook et al., 2018). Previous research has primarily focused on the implementation, adoption, and outcomes of telemedicine, often treating telemedicine IS as a "black box." Internal processes, such as the diagnosis process, have rarely been explored. A recent study by Ayabakan et al. 2023 examines how different disease conditions affect telehealth utilization. However, prior studies do not address the challenges posed by varying disease conditions during teleconsultations or how healthcare providers manage these challenges. There is limited research on how information constraints, caused by reduced sensory engagement and direct interaction during teleconsultations, impact downstream outcomes such as patient care and safety. Additionally, previous studies have mostly centered on patients and physicians, overlooking key roles like healthcare workers, technicians, and nurses, who are crucial for telemedicine's success, particularly in developing countries (Li et al. 2020; Chandwani et al. 2018). Many of these studies have adopted a technology-deterministic approach, focusing on IT artifacts while neglecting the social context of telemedicine. There is a lack of research that takes a socio-technical perspective, considering both IT artifacts and the social context.This thesis is organized into three essays to study different aspects of adaptations in telemedicine. Essay-1 investigates the emergence of adaptations by care providers during physician-patient consultations in telemedicine, identifying their triggers. A conceptual framework is built using Adaptive Structuration Theory (AST) (DeSanctis and Poole, 1994) for the study. Through a case study approach, the essay analyzes physician-patient teleconsultations across different telemedicine contexts using interviews and observations as data-gathering techniques. The findings reveal that care providers engaged in varied exploitive and exploratory technology and task adaptations triggered by various constraints and inadequacies. These adaptations resulted in the emergence of new structures, and care providers also enacted role multiplexity to handle dynamically changing situations during teleconsultations.Essay 2 focuses on the diagnosis process during teleconsultations to examine how care providers adapt technologies and care practices to address the challenges of limited Ayabakan et al. 2023 examines how different disease conditions affect telehealth utilization. However, prior studies do not address the challenges posed by varying disease conditions during teleconsultations or how healthcare providers manage these challenges. There is limited research on how information constraints, caused by reduced sensory engagement and direct interaction during teleconsultations, impact downstream outcomes such as patient care and safety. Additionally, previous studies have mostly centered on patients and physicians, overlooking key roles like healthcare workers, technicians, and nurses, who are crucial for telemedicine's success, particularly in developing countries (Li et al. 2020; Chandwani et al. 2018). Many of these studies have adopted a technology-deterministic approach, focusing on IT artifacts while neglecting the social context of telemedicine. There is a lack of research that takes a socio-technical perspective, considering both IT artifacts and the social context.This thesis is organized into three essays to study different aspects of adaptations in telemedicine. Essay-1 investigates the emergence of adaptations by care providers during physician-patient consultations in telemedicine, identifying their triggers. A conceptual framework is built using Adaptive Structuration Theory (AST) (DeSanctis and Poole, 1994) for the study. Through a case study approach, the essay analyzes physician-patient teleconsultations across different telemedicine contexts using interviews and observations as data-gathering techniques. The findings reveal that care providers engaged in varied exploitive and exploratory technology and task adaptations triggered by various constraints and inadequacies. These adaptations resulted in the emergence of new structures, and care providers also enacted role multiplexity to handle dynamically changing situations during teleconsultations.Essay 2 focuses on the diagnosis process during teleconsultations to examine how care providers adapt technologies and care practices to address the challenges of limited optimizing resource allocation and telemedicine design for different clinical specialities.

Pagination

viii, 279p.

Copyright

Indian Institute of Management Bangalore

Document Type

Dissertation

DAC Chairperson

Bandi, Rajendra K

DAC Members

De, Rahul; Ugargol, Allen P; Venkatagiri, Shankar

Type of Degree

Ph.D.

Relation

DIS-IIMB-FPM-P25-09

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