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Understanding the Normalization of Telemedicine Services through Qualitative Evaluation: Table 1
Open accessAbstract
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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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“The development of a set of explanatory ideas around normalization has shifted from an initial set of empirical generalizations presented as synthetic propositions or assertions [17], to a robust conceptual model that presented generalizable propositions [7], and finally to a middle-range theory that offers a set of mechanism-based explanations for processes of implementation, embedding, and integ”
From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [17]
In the citing paper
“P4 Stabilization of telemedicine systems in practice depends on integration at the level of professional knowledge and practice, where clinicians are able to accommodate telemedicine in their clinical activities through the development of new procedures and protocols.”
From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [17]
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Metadata
- Authors
- May, C., Harrison, R., Finch, T., MacFarlane, A., Mair, F., & Wallace, P.
- Affiliations
- University of Liverpool (GB)
- Corresponding author
- May, Carl
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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