TELEMEDICINE PRACTICES IN HIGH-RELIABILITY ENVIRONMENT

Abstract

Despite its documented benefits, using Telemedicine to deliver treatment in emergency environments is not without challenges. These challenges are mainly due to the system's technical limitations, time constraints, and uncertainty surrounding emergency conditions. By drawing on an ethnographic study in three medical institutions in Singapore, this thesis includes two studies that together tackle challenges of telemedicine in high reliability environments. The first paper examines the responses of teams when their technology-mediated routines are disrupted. The need for reliable performance in the face of unpredictable disruptions creates tensions between improvised responses and those that draw on a repertoire of established routines. The tensions create what I call a reliability paradox. I aim to unpack how the paradox manifests and the medical team members respond to disruptions of routines. The second paper focuses on the need for social presence between medical team members in telemedicine systems. The paper aims to explore conditions mechanisms of achieving social presence under time pressure. I draw on sensemaking theory to analyze how the medical team members make sense of what is happening on the other side of the telemedicine system and consequently generate a sense of social presence.