title: When protocols fail: technical evaluation, biomedical knowledge, and the social production of 'facts' about a telemedicine clinic.
abstract: Telecommunications systems seem to offer health care providers, professionals and patients a plethora of opportunities to respond to social and geographical inequalities in health care provision, and a new field of health care endeavor has emerged--'telemedicine'. This paper presents results from a three year ethnographic study of the development and implementation of telemedicine systems in a British region. We explore how attempts to put into service one 'telemedicine' system failed to get beyond the draft of a written protocol. Our analysis focuses on the contests between clinicians, technical experts and external evaluators over what kinds of knowledge and practice count in developing a protocol and evaluating a clinical intervention. We show how the introduction and implementation of 'hard' technologies (systems hardware) can be undermined in practice by 'soft' technologies (the practices through which evaluative knowledge is produced).
authors.affiliation: School of Primary Care, University of Manchester, Rusholme Health Centre, UK. cmay@man.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: May
authors.forename: N T
authors.initials: NT
authors.lastname: Ellis
mesh_terms: D001292:Attitude to Computers; D002985:Clinical Protocols; D004059:Diffusion of Innovation; D005069:Evaluation Studies as Topic; D005380:Financing, Government; D006297:Health Services Accessibility / Q000458:organization & administration*; D006779:Hospitals, Public; D006801:Humans; D009937:Organizational Objectives; D010865:Pilot Projects; D016730:Program Development / Q000191:economics / Q000379:methods*; D012959:Socioeconomic Factors; D013222:State Medicine / Q000458:organization & administration; D013673:Technology Assessment, Biomedical; D017216:Telemedicine / Q000295:instrumentation / Q000458:organization & administration*; D006113:United Kingdom