Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting

Area of Science:

• Health Informatics
• Surgical Technology
• Systems Engineering

Background:

• Telemedicine services for remote surgical consultation show promise but scaling up presents challenges.
• Contextual variations across clinical sites can impact telemedicine implementation and outcomes.
• Understanding complex healthcare contexts is crucial for successful telemedicine adoption.

Purpose of the Study:

• To systematically characterize implementation contexts for a telemedicine service scale-up.
• To identify functional constraints shaping clinical work at different hospital sites using Work Domain Analysis (WDA).
• To provide insights for informed implementation and assessment of telemedicine services.

Main Methods:

• Employed Work Domain Analysis (WDA), an engineering method for modeling complex work environments.
• Conducted observations and semistructured interviews with diverse healthcare stakeholders.
• Utilized thematic analysis guided by WDA concepts, focusing on objects, functions, priorities, and values.

Main Results:

• Characterized three constraint facets: treatment, administrative, and development.
• Identified variations in medical equipment, administrative processes, and resource availability across sites.
• Highlighted differences in training and research resources, potentially impacting telemedicine adoption.

Conclusions:

• Surgical work systems are influenced by multiple constraints that can be modeled using WDA.
• Site-specific variations may pose challenges for telemedicine service integration.
• Shared values and priorities, alongside adequate resources, can facilitate overcoming implementation disruptions.
• WDA effectively models complex sociotechnical contexts for telemedicine design and implementation.