Understanding the newly formed
conventions in telehealthcare: what can
the social sciences do for us?
Dr Yannis Pappas
Deputy Director, eHealth Unit
eHealth Unit - Imperial College London
Common investigative themes across eHealth
research and practice
• Optimisation of planning
• Enhancement of implementation
Different routes to reach to these objectives
• Financial viability
• Technological competence
• Managerial and organisational skills
Essential for the provision of successful telehealthcare initiatives.
What about human experience and skills?
A reasonable quote
As Whitten, Sypher and Patterson (2000) put it, ‘we know a
good deal about bandwidths and resolutions, but not enough
about the human dimensions that make practice possible’.
Healthcare as an “ecosystem”
A healthcare system is the result
of integration of at least four
What can the social sciences do for us?
By looking at various aspects of human experience and
conduct, the social sciences help us understand some of the
dynamics that may determine the success or the failure of
„It‟s just a PC…‟
Patients’ verbal behaviour was subject to:
1. The movement of the doctors' hands and fingers.
2. The relative intensity of keystrokes.
3. Shifts in the doctors' gaze from the keyboard to the monitor.
(Greatbatch et al., 1995).
Types and outcomes of social science research
Surveys and Interviews
• Users’ perceptions and experiences
• User satisfaction
Participant involvement methods
• Ergonomic system development Observational studies and
• Human factors engineering analyses of interaction
• Analysis of workflow
• Process change
• Organisational dynamics
A case study in real-time telemedicine
(Pappas & Seale, 2009)
•The patient at his/her local primary care
accompanied by a GP and/or a nurse.
•The consultant at a hospital examining
the patient via real-time
•The consultant has electronically
received results from tests previously run
at the surgery.
Integration or disruption?
• Allows most of care to take place in the community
• Contributes to professional education at both ends
• Minimises missing appointments
Something to consider:
• Such implementation may require disruptive reorganisation of
care and infrastructure support
• To perform a comparative analysis of communication between
participants in face-to-face and telemedicine consultations.
• To understand the newly formed communication conventions of
telemedicine consultations within their social and organisational
Conversation analysis has been used to analyse:
• Interaction in classroom activities (Mehan, 1979; McHoul,
• News interviews (Greatbatch, 1985)
• Counselling sessions (Hutchby, 2001)
• Talk in medical settings (Heath, 1986; West, 1984; Maynard,
1989; ten Have, 1999; Silverman, 1987; 1997).
Physical examination in telemedicine
(Televascular, C, P, N)
1 C: now if you could turn your legs outwards Mrs G. (2.1) and then
2 if you could go a little higher up (1.2) above the knees (0.5)
3 oka::y there are some varicose veins all the way up really on
4 the right[side] by the look of things
5 N: [yeah] Green: place the patient
6 C: come down again (5.2) and there is a pigmentation in the gator Orange: place the camera
8 N: yes Blue: online commentary
9 C: a little bit on both sides is that true H? Underlined: Explicit or implicit
11 (0.3) requests for verification
12 N: yes there is
13 (0.7) Online commentary may be
14 C: ºyesº (1.5) okay (0.7) and at the moment the left leg looks perceived by the nurse as a
15 more swollen is that correct? request for feedback
16 N: yes it i:s
17 C: alright Mrs G can I ask you to turn around and face away from
18 the camera?
19 (5.0) Red: involved in physical
20 P: feet out? examination as a facilitator for
21 (1.2) diagnosis. Physical proximity
22 C: yes that’s great (4.2) ºrightº (0.5) ºo:kayº (4.6) now there to the patient is utilised to
23 are one or two varicose veins at the back but not an awful lot= verify or contest the
24 N: =no:= consultant’s observations
25 C: my view at least (1.0) is that how you see it H?
26 N: yea:h it’s not too: bad rea:lly
27 C: okay if you could take a sit Mrs G to have a look at the lower leg
Management negotiation in telemedicine
(Telecardiology, C, GP)
1 GP: I am just wondering if it is all alcohol damage
2 C: it- it's thickened it's definitely thickened and it is
4 GP: so alcohol would do (.) generally would it
5 C: no alcohol make it thin and weak (.) and dilated it wouldn't
6 do this
7 GP: okay
8 C: all the other dimensions are normal
9 GP: okay
10 C: just a wall thickened
11 GP: okay
12 C: so:: I would suggest that you repeat that echo and re-assess
13 GP: alright
14 C: and then get a profusion scan
15 GP: okay
Telemedicine is an unfamiliar terrain which requires constant
negotiation of communication skills and roles. Participant skills
in telemedicine are influenced by four characteristic traits of
a) the novelty of the institutional setting
b) the introduction of additional persons in the consultation
c) the inability of the consultant to physically examine the patient
d) the technological apparatus used
• Facilitates communication between primary and tertiary care.
• Takes place in an unfamiliar physical space and involves a
degree of uncertainty in currying out various activities
• Enhances the role of the nurse in the consultation
• Produces conflicts of agendas and negotiation over the
communicative floor between primary and tertiary care staff
• Contributes to GP and nurse education – any other professional
in other modalities
• May exclude the patient from certain parts of the consultation
because of extensive interprofessional talk
• Requires additional skills by consultants
Need for more social sciences research in eHealth
• Low cost
• Proven validity
• User involvement
Understanding the newly formed conventions in telehealthcare: what
can the social sciences do for us?
Dr Yannis Pappas
eHealth Unit – Imperial College London