title: Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders.
abstract: Real-time videoconferencing technology such as clinical video telehealth (CVT) offers a means to reach patient populations who face limited access to healthcare. The Veterans Health Administration has invested in CVT to improve care access for U.S. military veterans with spinal cord injuries and disorders (SCI/D); however, no studies have assessed the factors that influence implementation of this technology in clinical practice for individuals with SCI/D.
  
  
  
  Guided by a sociotechnical perspective, the purpose of this study was to identify factors that influence implementation of CVT for veterans with SCI/D.
  
  
  
  We conducted semistructured telephone interviews with 40 healthcare providers who use CVT to deliver services to veterans with SCI/D.
  
  
  
  Factors related to workflow and communication were widely reported as implementation barriers. Coordinating logistics for CVT appointments was challenging, and effective communication between CVT team members across facilities was considered crucial. Providers also cited factors related to technical infrastructure, people, and organizational features, including the need for appropriate equipment, space, personnel, and support for using CVT equipment.
  
  
  
  The implementation of CVT in the care of veterans with SCI/D was influenced by an interrelated set of social and technical factors. Key among them were social factors related to people, workflow, and communication, given that CVT supports healthcare teams interacting remotely in real time.
  
  
  
  CVT implementation requires teams working together to negotiate a complex, distributed process across multiple sites. Such complexity places a premium on teamwork and communication among healthcare teams before, during, and after a CVT encounter.
authors.affiliation: 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.
authors.forename: Rachael N
authors.initials: RN
authors.lastname: Martinez
authors.affiliation: 2 Center for Healthcare Organization and Implementation Research , Edith Nourse Rogers Memorial Veterans Hospital, U.S. Department of Veterans Affairs, Bedford, Massachusetts.|3 Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hogan
authors.affiliation: 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.|4 Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Salva
authors.initials: S
authors.lastname: Balbale
authors.affiliation: 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.
authors.forename: Keshonna
authors.initials: K
authors.lastname: Lones
authors.affiliation: 5 Spinal Cord Injuries and Disorders System of Care Program Office , U.S. Department of Veterans Affairs, Seattle, Washington.|6 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
authors.affiliation: 7 Louis Stokes Cleveland DVAMC , U.S. Department of Veterans Affairs, Cleveland, Ohio.
authors.forename: Christine
authors.initials: C
authors.lastname: Woo
authors.affiliation: 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.|8 Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000628:therapy*; D017216:Telemedicine / Q000379:methods* / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health / Q000706:statistics & numerical data / Q000639:trends; D049269:Videoconferencing
keywords: communication; coordination; sociotechnical model; spinal cord injury; teamwork; telehealth; telemedicine; veteran