THE TELEMEDICINE ORGANIZATION: HOW TO MAKE IT WORK

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THE TELEMEDICINE ORGANIZATIONHOW TO MAKE IT
WORK

• I. H. Monrad Aas, PhD
• The Work Research Institute,
• Oslo, Norway
• E-mail monrad.aas_at_broadpark.no

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• 
  
• On a historic basis technology has been a
• force for organizational change in health care
• Organizational consequences have been given
• much attention in the telemedicine community
• For telemedicine we have some empirical
• studies of organizational consequences
• 
  
• 
  
  

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• - In two Norwegian projects empirical data have
• been collected. Start in the late 1990ies
• Respondents asked questions. Qualitative
• questionnaires
• Studies of remote consultations and
  teleradiology.
• Clearly different applications. Synchronous and
• asynchronous collaboration

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• 
  
• COLLABORATION
• Collaboration, in general, does not necessarily
• work well and significant problems for
• collaboration across organizational borders
• With telemedicine collaboration across
• organizational borders. In addition
• collaboration with the aid of technology
• Important that telemedicine collaboration
• works well.

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TELERADIOLOGY 17 measures of
importance for collaboration identified, for
example Make someone responsible and
distribute tasks, the involved should know one
another, adress problems of attitude, management
support important, organizational merger
improves collaboration, organize time for
teleradiololgy at departments, and high volume
gives better collaboration.
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TELEMEDICINE REMOTE CONSULATIONS 10 measures of
importance for collaboration indentified, for
example Make someone responsible and
distribute tasks, the involved should know one
another, high volume gives better collaboration,
and make schedule for coming half year to make
it easy to meet at the same time.
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• - Similarity in collaboration measures for
• teleradiology and remote consultations
• Collaboration measures for other applications
• may have similarity
• Organizations planning larger volumes of
• telemedicine have a job to do
• Managers should lead change processes
• where collaboration problems are treated
• 
  

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NETWORKED REGIONAL ORGANIZATION - How can
services be organized in geographic areas, for
example regions? The case of
teleradiology - The question is not at least
where to perform interpretation of images
- Centralization an important term
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Centralization def. Performing all, or parts,
of the radiology image interpretation at fewer
organizational units than before PACS/
teleradiology Geographic centralization of
three types Centralization to one location
only, to fewer locations than before, and to
rotation between several locations

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Radiology functions which can be centralized
to fewer locations, seven types All functions,
24 hour duties, radiology specialities, second
opinion, functions for a limited time, radiology
for referred ambulatory patients,
routine radiology - Each
radiology function can be combined with each
type of geographic centralization.

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• Means we have indentified 21 (7x3)
• combinations, or 21 theoretically possible
• types of centralization. To obtain overview a
• cross-table can be used.
• Advantages, e.g.
• better distribution of workload, improved
• quality of interpretations, economic
  advantages
• (e.g economies of scale).

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• Disadvantages, e.g.
• capturing images may require the presence of
• a radiologist, changes in radiologists contact
  
• with clinicians, clinico-radiological
• conferences more difficult to organize
• - New regional organization can make more
• teleradiology necessary.
• Centralization and decentralization also
  relevant
• for other applications

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• - Involvement of management and policy level
• important
• The title of the presentation virtual
  organization
• within existing organization, organizational
• problems crucial for the future of
  telemedicine
• - Given a brief introduction to a research with
  
• more than 30 publications