title: Providing rehabilitation online - invisible work and diagnostic agents.
abstract: OBJECTIVE
  Telecare promises to deliver healthcare services more efficiently while, at the same time, improving the quality of care. The purpose of this paper is to challenge these promises by analysing the implications of introducing telecare in the rehabilitation of patients suffering from chronic obstructive pulmonary disease.
  
  
  METHODS
  Empirically, the paper is based on interviews with and observations of rehabilitation therapists and patients taking part in a Danish telerehabilitation programme. Theoretically, the paper draws on Science and Technology Studies.
  
  
  RESULTS
  The introduction of telecare alters rehabilitation practices in multiple ways. First, several new time-consuming work routines, carried out in collaboration between therapists, patients and technical professions, emerge. Although crucial in establishing and maintaining telerehabilitation infrastructures, this work remains invisible in evaluations of the programme. Second, rather than simply increasing patient agency, responsibilities are redistributed and negotiated in subtle and non-uniform ways. These negotiations make it less transparent where one responsibility begins and where another potentially conflicting one ends.
  
  
  CONCLUSIONS
  Evaluations of telecare technologies should pay more attention to work- and responsibility-related effects of introducing telecare in order better to account for predicted and unpredicted as well as desirable and undesirable socio-technical changes.
  
  
  CONCLUSIONS
  Using an ethnographic approach, the paper points to the discrepancy between simplistic political promises that telecare technologies can serve as tools for improvement, on the one hand, and the substantial changes in the organisation and management of healthcare observed in practice, on the other. Rather than regarding telecare as technologies of improvement, it is more productive to regard them as technologies of change.
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Malene
authors.initials: M
authors.lastname: Bødker
authors.forename: Annegrete
authors.initials: A
authors.lastname: Juul Nielsen
mesh_terms: D003299:Cooperative Behavior; D003718:Denmark; D006801:Humans; D007407:Interviews as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D036301:Qualitative Research; D012648:Self Care; D017216:Telemedicine
keywords: Healthcare; Organisation-of-care; Qualitative research; Technology; User studies; Work