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Cited by 155Telemedicine and Telehealth ImplementationElectronic Health Records SystemsHealth Policy Implementation Science

Understanding the Normalization of Telemedicine Services through Qualitative Evaluation: Table 1

Open access
May, Carl, Harrison, Robert, Finch, Tracy, MacFarlane, Anne, Mair, Frances, Wallace, Paul·2003·Journal of the American Medical Informatics Association
DOI 10.1197/jamia.m1145PMC PMC264438
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Abstract

OBJECTIVE: Qualitative studies can help us understand the "successes" and "failures" of telemedicine to normalize within clinical service provision. This report presents the development of a robust conceptual model of normalization processes in the implementation and development of telemedicine services. DESIGN: Retrospective and cumulative analysis of longitudinal qualitative data from three studies was undertaken between 1997 and 2002. Observation and semistructured interviews produced a substantial body of data relating to approximately 582 discrete data collection episodes. Data were analyzed separately in each of three studies. Cumulative analysis was conducted by constant comparison. RESULTS: (1) Implementation of telemedicine services depends on a positive link with a (local or national) policy level sponsor. (2) Adoption of telemedicine systems in service depends on successful structural integration so that development of organizational structures takes place. (3) Translation of telemedicine technologies into clinical practice depends on the enrollment of cohesive, cooperative groups. (4) Stabilization of telemedicine systems in practice depends on integration at the level of professional knowledge and practice, where clinicians are able to accommodate telemedicine through the development of new procedures and protocols. CONCLUSION: A rationalized linear diffusion model of "telehealthcare" is inadequate in assessing the potential for normalization, and the political, organizational, and "ownership" problems that govern the process of development, implementation, and normalization need to be accounted for. This report presents a model for assessing the potential for successful implementation of telehealthcare services. This model defines the requirements for the successful normalization of telemedicine systems in clinical practice.

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  • Complex relationships between the technical, social and organisational dimensions need to be negotiated to achieve implementation.

    “two other reports [11, 12] conclude that complex relationships between the technical, social and organisational dimensions need to be negotiated to achieve implementation”

    From Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study (2016) · cites this paper as [12]

  • Translation of telemedicine technologies into clinical practice depends on the enrolment of heterogeneous actors into relatively cohesive, co-operative groups, in which functional identities are negotiated and established a priori and powers relatively well defined.

    “P3 Translation of telemedicine technologies into clinical practice depends on the enrolment of heterogeneous actors into relatively cohesive, co-operative groups, in which functional identities are negotiated and established a priori and powers relatively well defined.”

    From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [17]

  • Implementation of telemedicine services depends on a positive link with a (local or national) policy level sponsor, so that telemedicine is defined as an appropriate means of delivering care, and appropriate infrastructures are developed.

    “P1 Implementation of telemedicine services depends on a positive link with a (local or national) policy level sponsor, so that telemedicine is defined as an appropriate means of delivering care, and appropriate infrastructures are developed.”

    From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [17]

  • The normalisation of telemedicine as a means of health care delivery (in whatever setting, and at whatever level of healthcare provision) is conditional on P1 + P2 + P3 + P4.

    “P5 The normalisation of telemedicine as a means of health care delivery (in whatever setting, and at whatever level of healthcare provision) is conditional on P1 + P2 + P3 + P4.”

    From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [17]

  • Adoption of telemedicine systems in service depends on successful integration at the level of structural legitimation so that it is supported as, and thus practically incorporated into, health care delivery through the development of organizational structures.

    “P2 Adoption of telemedicine systems in service depends on successful integration at the level of structural legitimation so that it is supported as, and thus practically incorporated into, health care delivery through the development of organizational structures.”

    From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [17]

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Authors
May, C., Harrison, R., Finch, T., MacFarlane, A., Mair, F., & Wallace, P.
Affiliations
University of Liverpool (GB)
Corresponding author
May, Carl
ORCID
Venue
Journal of the American Medical Informatics Association
Publisher
Oxford University Press (OUP)
Published
2003-11
Volume
10
Issue
6
Pages
596-604
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
DOI
10.1197/jamia.m1145
PMC
PMC264438
OpenAlex
W2113222987
Cited by
155
References
56
Citations by year
2026: 5 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 7 · 2020: 11 · 2019: 6 · 2018: 11 · 2017: 7 · 2016: 13 · 2015: 8 · 2014: 5 · 2013: 6 · 2012: 8
FWCI
4.06
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Medical Informatics Association (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • Northumbria Research Link (Northumbria University) (submittedVersion)
  • University of Galway Research Repository (submittedVersion, cc-by-nc)
  • Research Repository UCD (University College Dublin) (cc-by-nc)
Funders
  • Health Service Executive
  • Economic and Social Research Council
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
telemedicine, normalization process, conceptual model, organizational integration, clinician adoption, professional knowledge and practice, diffusion of innovations, clinical practice change
MeSH terms
Diffusion of Innovation, Evaluation Studies as Topic, Health Services Administration, Health Services Research, Longitudinal Studies, Organizational Innovation, Retrospective Studies, Telemedicine

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