Abstract
Currently telehealth is being offered as an innovative solution to austerity, staffing issues and problems accessing care in Canada’s rural communities. Despite the current enthusiasm for telehealth in provincial and federal policy documents, many of these promises have not been realized. The Labrador region is a large and sparsely populated area that was vested with a federal “Smart Community” project to increase the region’s technological capacity, making it one of the most connected locales in the country. While telehealth was a key component of the SmartLabrador plan, there has been limited uptake of newly available technologies for the purposes of mediating distance in health care. My work critically examines the factors surrounding this lack of uptake, and takes the work of Harold Innis as a starting point when analyzing the breakdown of time and space in Labrador. Focused around qualitative field research conducted in Labrador in 2003, I explore spatialization, structuration and work practice as they relate to telehealth use and non-use in the region. I review federal and provincial telehealth policy to provide a macro context for the study, which I then link to meso and micro levels of analysis in organization structures and situated work practice. I examine telehealth in the user context from the health care provider perspective. This reveals several constraints that have limited the usage of new technologies for health communication in Labrador. The user context must be considered in the design of telehealth programs and policy if the desired outcomes for telehealth are to be realized. The barriers to telehealth use are not simply technical, but relate to issues of privacy, culture and trust. I discuss these and other barriers with a focus on the needs of the Labrador community.
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References
Balka E. (2002). The Invisibility of the Everyday: New Technology and Women’s Work. In: Meehan E.R., Riordan E. (Eds.), Sex and Money: Feminism and Political Economy in the Media. Minneapolis: University of Minnesota Press. (pp. 60–74)
Bush C.G. (1983). Women and the Assessment of Technology: To Think, To Be, To Unthink, To Free. In: Rothschild J. (Ed.), Machina Ex Dea: Feminist Perspectives on Technology. New York: Pergamon
Canada (2000): Evaluating Telehealth ‘Solutions’: A Review and Synthesis of the Telehealth Evaluation Literature. Ottawa: Health Canada: Office of Health and the Information Highway
Canada (2003a): First Nations and Inuit Telehealth Research Project: Future Opportunities. Ottawa: Health Canada
Canada (2003b): Smart Community Program. Retrieved March 14, 2003, from <http://smartcommunities.ic.gc.ca/program_e.asp>
Canada (2006): Federal Electoral District Profile of Labrador, Newfoundland and Labrador (2003 Representation Order), 2001 Census. Retrieved May 28, 2006 from <http://www12.statcan.ca/english/census01/products/standard/fedprofile /RetrieveTable.cfm?R=FED03&G=10004>
Canadian Institute for Health Information (2003): Retrieved March 5, 2003, from <www.cihi.gc.ca>
Carey J.W. (1989). Communication as Culture. Winchester, MA: Unwin Hyman Inc
Comor E. (2001). Harold Innis and the Bias of Communication. Information, Communication & Society, 4(2): 274–294
Connecting Canadians (2003). Retreived March 5, 2003 from <www.connect.gc.ca>
Dunn G.W. (2004). Legal Issues Confronting 21st-century Telehealth. British Columbia Medical Journal 46(6): 290–292
Elford D.R. (1998). Telemedicine Activities at Memorial University of Newfoundland – A Historical Review: 1975–1997 Telemedicine Journal 4(3): 207–224
Giddens A. (1984). The Constitution of Society: Outline of the Theory of Structuration. Los Angeles: University of California Press
Giddens A. (1989). Sociology. Cambridge: Polity Press
Grint, K. and S. Woolgar (1997): The Machine at Work: Technology, Work and Organization: Polity Press
Hailey, D. (2005): Technology and Managed Care: Is Telemedicine the Right Tool for Rural Communities? Journal of Postgraduate Medicine, vol. 51, no. 4, pp. 275–278
Hailey D., Roine R., Ohinmaa A. (2001). Assessments of Telemedicine Appliciations - An Update. Edmonton: Alberta Heritage Foundation for Medical Research
Health Telematics Unit. (2003): Socio-Economic Impact of Telehealth: Evidence Now for Health Care in the Future. Calgary, AB: Telehealth and e-health Research and Training Program, Faculty of Medicine, University of Calgary
Innis H. (1994a). A Plea for Time. In: Drache D. (Ed.), Staples, Markets and Cultural Change. Montreal: McGill-Queen’s
Innis H. (1994b). The Problem of Space. In: Drache D. (Ed.), Staples, Markets and Cultural Change. Montreal: McGill-Queen’s
Jennett, P.A., M.P. Gagnon and H.K. Brandstadt. (2005): Preparing for Success: Readiness Models for Rural Telehealth. Journal of Postgraduate Medicine, vol. 51, no. 4, pp. 279–285
Jennett P.A., Andruchuk K. (2001). Telehealth: ‘Real Life’ Implementation Issues Computer Methods and Programs in Biomedicine 64: 169–174
Jennett, P.A., M.M. Watson and M. Watanabe (2000): The Potential Effects of Telehealth on the Canadian Health Workforce: Where is the Evidence? CyberPsychology and Behavior, vol. 3, no. 6, pp. 917–923
Mosco V. (1996). Political Economy of Communication. Thousand Oaks: Sage
Muttitt, S., R. Vigneault and L. Loewen (2004): Integrating Telehealth into Aboriginal Healthcare: The Canadian Experience. Journal of Circumpolar Health, vol. 63, no. 4, pp. 401–414
National Initiative for Telehealth (NIFTE) (2003): Environmental Scan of Organizational, Technology, Clinical and Human Resource Issues. Calgary, AB
Noorani H.Z., Picot J. (2001). Assessment of Videoconferencing in Telehealth in Canada. Ottawa, ON: Canadian Coordinating Office of Health Technology Assessment
Ohinmaa, A. and D. Hailey (2002): Telemedicine, Outcomes and Policy Decisions. Disease Management and Health Outcomes, vol. 10, no. 5, pp. 269–276
Romanow R.J. (2002). Building on Values: The Future of Health Care in Canada. Saskatoon, SK: Commission on the Future of Health Care in Canada
Sharpe, C.C. (2001): Telenursing: Nursing Practice in Cyberspace. Westport, Connecticut
Suchman L. (1987). Plans and situated actions: the problem of human-machine communication. New York: Cambridge University Press
Suchman L., Blomberg J., Orr J., Trigg R. (1999). Reconstructing Technologies as Social Practices. American Behavioral Scientist 43(3): 392–408
Veenhof B., Neogi P., van Tol B. (2003). High-Speed on the Information Highway: Broadband in Canada. Ottawa: Industry Canada, Science, Innovation and Electronic Information Division
Acknowledgements
The author would like to acknowledge the contributions of the Social Sciences and Humanities Research Council Grant From Work Practice to Health Policy: Case Studies of the Canadian Health Information Highway and of community partner SmartLabrador to this research. Additionally, the author would like to thank the many health care and community development workers who generously contributed their time.
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This paper is based on research conducted in partnership with the SmartLabrador initiative, a federal Smart Community project which grew out of the grassroots Labrador Information Technology Initiative. This partnership helped me to establish contact with telehealth stakeholders in the region; paid for a portion of research travel; and provided me with an office and home base for the duration of the fieldwork. This research was conducted as part of the SSHRC funded project “From Work Practice to Public Policy: Case Studies of the Canadian Health Infostructure”.
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Peddle, K. Telehealth in Context: Socio-technical Barriers to Telehealth use in Labrador, Canada. Comput Supported Coop Work 16, 595–614 (2007). https://doi.org/10.1007/s10606-006-9030-3
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DOI: https://doi.org/10.1007/s10606-006-9030-3