Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders
Open accessAbstract
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.
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An investigation of video consulting scale-up for spinal cord injury suggested a common concern was perceived limits to evaluate physical symptoms over video and difficulty to assess clients' complaints without physical examination.
“For example, an investigation of video consulting scale-up for spinal cord injury suggested that a “common concern was the perceived limits to evaluate physical symptoms over [video]” and the difficulty to assess clients’ complaints without being able to physically examine them [35].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [35]
Authors reported that support and high-quality training were necessary to achieve widespread growth.
“Authors reported that support and high-quality training were necessary to achieve widespread growth [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [35]
Other telehealth champion roles included health care coordinators or IT staff.
“Other roles included health care coordinators or IT staff [33,35,40,43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [35]
Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 reviewed articles.
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [35]
At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all 13 reviewed studies.
“At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all studies (n=13) [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [35]
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- Authors
- Martinez, R. N., Hogan, T. P., Balbale, S., Lones, K., Goldstein, B., Woo, C., & Smith, B. M.
- Affiliations
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.
- United States Department of Veterans Affairs (US)
- Northwestern University (US)
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2017-07
- Volume
- 23
- Issue
- 7
- Pages
- 567-576
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC5802248
- OpenAlex
- W2592945901
- Cited by
- 35
- References
- 40
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 3
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship@UMassChan (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK101363)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- veterans, implementation barriers, socio-technical approach, healthcare provider perspectives, workflow, communication, technological infrastructure, Veterans Health Administration
- MeSH terms
- Adult, Delivery of Health Care, Female, Forecasting, Humans, Male, Middle Aged, Spinal Cord Injuries, United States, United States Department of Veterans Affairs, Veterans, Telemedicine, Videoconferencing, Veterans Health
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