Sustainable Rural Telehealth Innovation: A Public Health Case Study

Objective. To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable. Study Setting. Longitudinal, qualitative study (1988–2008) of the largest public health district in Georgia. Study Design. Case study design provided deep insights int...

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Published inHealth services research Vol. 45; no. 4; pp. 985 - 1004
Main Authors Singh, Rajendra, Mathiassen, Lars, Stachura, Max E., Astapova, Elena V.
Format Journal Article
LanguageEnglish
Published Malden, USA Blackwell Publishing Inc 01.08.2010
Health Research and Educational Trust
Blackwell Publishing Ltd
Blackwell Science Inc
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Summary:Objective. To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable. Study Setting. Longitudinal, qualitative study (1988–2008) of the largest public health district in Georgia. Study Design. Case study design provided deep insights into the innovation's social dynamics. Punctuated equilibrium theory helped present and make sense of the process. We identified antecedent conditions and outcomes, and we distinguished between episodes and encounters based on the disruptive effects of events. Data Collection. Twenty‐five semistructured interviews with 19 decision makers and professionals, direct observations, published papers, grant proposals, technical specifications, and other written materials. Principal Findings. Strong collaboration within the district, with local community, and with external partners energized the process. Well‐functioning outreach clinics made telehealth desirable. Local champions cultivated participation and generative capability, and overcame barriers through opportunistic exploitation of technological and financial options. Telehealth usage fluctuated between medical and administrative operations in response to internal needs and contextual dynamics. External agencies provided initial funding and supported later expansion. Conclusions. Extensive internal and external collaboration, and a combination of technology push and opportunistic exploitation, can enable sustainable rural telehealth innovation.
Bibliography:istex:8526DF1B13C9D2EA0B785A91F12296ED02D4A482
ark:/67375/WNG-CX5QTHFL-Q
ArticleID:HESR1116
rsingh@ceprin.org
Lars Mathiassen, Ph.D., Professor, is with the Computer Information Systems, Center for Process Innovation, J. Mack Robinson College of Business, Georgia State University, Atlanta, GA. Max E. Stachura, M.D., Professor, is with the Departments of Medicine and Physiology, Center for Telehealth, Medical College of Georgia, Augusta, GA. Elena V. Astapova, M.D., Ph.D., Assistant Professor, is with the Department of Medicine, Center for Telehealth, Medical College of Georgia, Augusta, GA.
Address correspondence to Rajendra Singh, Ph.D. candidate, Center for Process Innovation, J. Mack Robinson College of Business, Georgia State University, 35 Broad Street, NW, Suite 400, Atlanta, GA 30303; e‐mail
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ISSN:0017-9124
1475-6773
DOI:10.1111/j.1475-6773.2010.01116.x