Technical Infrastructures Need to be Accompanied by Social Models of Telemedical Care
By the team from the University of Vienna

Responding to the local specificities also means acknowledging that the technologies in the projects are more than just technical devices. To be implemented successfully and sustainably, these technologies need to be taken up and integrated into the clinical routines. In our visits to the hospitals, we have observed how the newly installed technologies changed the ICU as a space. MONA has been added to the existing medical devices at the bedside, and break rooms have been repurposed as the telemedical cockpit. The medical staff sometimes had to develop new routines. Some of the ICUs that use MONA for telemedical consultations have established a second, telemedical ward round to discuss patients with their telemedical counterparts. Telemedical consultations require new ways of documenting and making decisions. Users had to learn new skills for communicating the patient to a remote consultant, compensating for the reduced sensory experience of the patient in the case of being present at the bedside.

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These observations show that implementing new technologies within ICU4Covid does more than adding technical equipment to the ICUs. It also changes the social dynamics in the ICU and are meant to create new networks of exchange and support. Therefore, as social scientists in the project, we speak of the “socio-technical implementation” of these technologies: The technical infrastructure needs to come hand in hand with a social model of how the technologies will be used in practice. This starts with developing a vision of using telemedicine together with future users before the installation. Many of the medical staff we spoke to expressed concern that they did not yet know how to integrate MONA into their practice. It continues with a close collaboration between producers and users throughout and after the installation to make telemedicine a routine. Thus far, the focus has been on rolling out the technologies. For the remaining months in the project, the outlines of corresponding social models for each of the hospitals need to be developed.