THE TELEMEDICINE ORGANIZATION: HOW TO MAKE IT WORK I. H. Monrad Aas, PhD The Work Research Institute, Oslo, Norway

- On a historic basis technology has been a force for organizational change in health care - Organizational consequences have been given much attention in the telemedicine community - For telemedicine we have some empirical studies of organizational consequences

- In two Norwegian projects empirical data have been collected. Start in the late 1990ies - Respondents asked questions. Qualitative questionnaires - Studies of remote consultations and teleradiology. Clearly different applications. Synchronous and asynchronous collaboration

COLLABORATION - Collaboration, in general, does not necessarily work well and significant problems for collaboration across organizational borders - With telemedicine collaboration across organizational borders. In addition collaboration with the aid of technology - Important that telemedicine collaboration works well.

TELERADIOLOGY 17 measures of importance for collaboration identified, for example: Make someone responsible and distribute tasks, the involved should know one another, adress problems of attitude, management support important, organizational merger improves collaboration, organize time for teleradiololgy at departments, and high volume gives better collaboration.

TELEMEDICINE REMOTE CONSULATIONS 10 measures of importance for collaboration indentified, for example: Make someone responsible and distribute tasks, the involved should know one another, high volume gives better collaboration, and make schedule for coming half year to make it easy to meet at the same time.

- Similarity in collaboration measures for teleradiology and remote consultations - Collaboration measures for other applications may have similarity - Organizations planning larger volumes of telemedicine have a job to do - Managers should lead change processes where collaboration problems are treated

NETWORKED REGIONAL ORGANIZATION - How can services be organized in geographic areas, for example regions? The case of teleradiology: - The question is not at least where to perform interpretation of images - Centralization an important term

Centralization def.: Performing all, or parts, of the radiology image interpretation at fewer organizational units than before PACS/ teleradiology Geographic centralization of three types: Centralization to one location only, to fewer locations than before, and to rotation between several locations

Radiology functions which can be centralized to fewer locations, seven types: All functions, 24 hour duties, radiology specialities, second opinion, functions for a limited time, radiology for referred ambulatory patients, routine radiology - Each radiology function can be combined with each type of geographic centralization.

Means we have indentified 21 (7x3) combinations, or 21 theoretically possible types of centralization. To obtain overview a cross-table can be used. - Advantages, e.g.: better distribution of workload, improved quality of interpretations, economic advantages (e.g economies of scale).

- Disadvantages, e.g.: capturing images may require the presence of a radiologist, changes in radiologist’s contact with clinicians, clinico-radiological conferences more difficult to organize - New regional organization can make more teleradiology necessary. - Centralization and decentralization also relevant for other applications

- Involvement of management and policy level important - The title of the presentation: virtual organization within existing organization, organizational problems crucial for the future of telemedicine - Given a brief introduction to a research with more than 30 publications