It came in the form of an excellent academic study published in BMJ Open, so you can read the full text. This must-read item is called The organising vision for telehealth and telecare: discourse analysis by Trisha Greenhalgh, Rob Procter, Joe Wherton, Paul Sugarhood and Sara Shaw. What the authors have done is to scour articles on these topics and synthesised from them four main views (‘discourses’) of these technologies that underlie the writings. They are:
- Utopian: That assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe ‘smart’ home environment where help was always at hand, while generating efficiency savings.
- Humanist: Emphasising the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems.
- Political economy: Envisages a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business.
- Change management: That recognises the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes.
They point out that the four conflicting discourses ‘engaged only minimally with one another’s arguments.’
The conclusion is that “Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, ‘talk past’ each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.”
This is a big, helpful step on the way to getting a global agreement on the terminology. But how are we to whip, cajole or entice these wild horses into line?