title: Integrating service development with evaluation in telehealthcare: an ethnographic study.
abstract: OBJECTIVE
  To identify issues that facilitate the successful integration of evaluation and development of telehealthcare services.
  
  
  METHODS
  Ethnographic study using various qualitative research techniques to obtain data from several sources, including in-depth semistructured interviews, project steering group meetings, and public telehealthcare meetings.
  
  
  METHODS
  Seven telehealthcare evaluation projects (four randomised controlled trials and three pragmatic service evaluations) in the United Kingdom, studied over two years. Projects spanned a range of specialties-dermatology, psychiatry, respiratory medicine, cardiology, and oncology.
  
  
  METHODS
  Clinicians, managers, technical experts, and researchers involved in the projects.
  
  
  CONCLUSIONS
  Key problems in successfully integrating evaluation and service development in telehealthcare are, firstly, defining existing clinical practices (and anticipating changes) in ways that permit measurement; secondly, managing additional workload and conflicting responsibilities brought about by combining clinical and research responsibilities (including managing risk); and, thirdly, understanding various perspectives on effectiveness and the limitations of evaluation results beyond the context of the research study.
  
  
  CONCLUSIONS
  Combined implementation and evaluation of telehealthcare systems is complex, and is often underestimated. The distinction between quantitative outcomes and the workability of the system is important for producing evaluative knowledge that is of practical value. More pragmatic approaches to evaluation, that permit both quantitative and qualitative methods, are required to improve the quality of such research and its relevance for service provision in the NHS.
authors: Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 3DN. Tracy.Finch@newcastle.ac.uk
authors: Tracy
authors: T
authors: Finch
authors: Carl
authors: C
authors: May
authors: Frances
authors: F
authors: Mair
authors: Maggie
authors: M
authors: Mort
authors: Linda
authors: L
authors: Gask
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006801:Humans; D011364:Professional Practice; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D013673:Technology Assessment, Biomedical; D017216:Telemedicine / Q000458:organization & administration* / Q000592:standards