Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders
Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders
复制标题
DOI：
10.1089/tmj.2016.0200
复制
发表时间：
2017-07-01
影响因子：
4.7
通讯作者：
Smith, Bridget M.
中科院分区：
文献类型：
--
作者：
Martinez, Rachael N.;Hogan, Timothy P.;Smith, Bridget M.
背景：实时视频会议技术，如临床视频远程医疗（CVT），提供了一种手段，以达到患者群体谁面临有限的医疗保健。退伍军人健康管理局已投资于CVT，以改善患有脊髓损伤和疾病（SCI/D）的美国退伍军人的护理机会；然而，没有研究评估影响该技术在SCI/D患者临床实践中的实施的因素。在社会技术视角的指导下，本研究的目的是确定影响脊髓损伤/伤残退伍军人实施CVT的因素。材料和方法：我们对40名使用CVT为SCI/D退伍军人提供服务的医疗服务提供者进行了半结构化的电话访谈。结果：与工作流程和沟通相关的因素被广泛报道为实施障碍。协调CVT任命的后勤工作具有挑战性，CVT团队成员之间跨设施的有效沟通被认为是至关重要的。供应商还提到了与技术基础设施、人员和组织特征相关的因素，包括对使用CVT设备的适当设备、空间、人员和支持的需求。讨论：CVT在脊髓损伤退伍军人护理中的实施受到一系列相互关联的社会和技术因素的影响。其中的关键因素是与人员、工作流程和通信相关的社会因素，因为CVT支持医疗团队进行远程实时交互。结论：CVT的实现需要团队一起工作来协商一个复杂的、跨多个站点的分布式过程。这种复杂性使得在CVT之前、期间和之后，医疗团队之间的团队合作和沟通变得非常重要。
Background:Real-time videoconferencing technology such as clinical video telehealth (CVT) offers a means to reach patient populations who face limited access to healthcare. The Veterans Health Administration has invested in CVT to improve care access for U.S. military veterans with spinal cord injuries and disorders (SCI/D); however, no studies have assessed the factors that influence implementation of this technology in clinical practice for individuals with SCI/D.Introduction:Guided by a sociotechnical perspective, the purpose of this study was to identify factors that influence implementation of CVT for veterans with SCI/D.Materials and Methods:We conducted semistructured telephone interviews with 40 healthcare providers who use CVT to deliver services to veterans with SCI/D.Results:Factors related to workflow and communication were widely reported as implementation barriers. Coordinating logistics for CVT appointments was challenging, and effective communication between CVT team members across facilities was considered crucial. Providers also cited factors related to technical infrastructure, people, and organizational features, including the need for appropriate equipment, space, personnel, and support for using CVT equipment.Discussion:The implementation of CVT in the care of veterans with SCI/D was influenced by an interrelated set of social and technical factors. Key among them were social factors related to people, workflow, and communication, given that CVT supports healthcare teams interacting remotely in real time.Conclusions:CVT implementation requires teams working together to negotiate a complex, distributed process across multiple sites. Such complexity places a premium on teamwork and communication among healthcare teams before, during, and after a CVT encounter.