When protocols fail: technical evaluation, biomedical knowledge, and the social production of 'facts' about a telemedicine clinic.
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).
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School of Primary Care, University of Manchester, Rusholme Health Centre, UK. cmay@man.ac.uk
Ellis
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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