Background: This research analyzes teleconsultation from both a mechanistic and complex adaptive system (CAS)\ndominant logic in order to further understand the influence of dominant logic on utilization rates of teleconsultation\nprojects. In both dominant logics, the objective of teleconsultation projects is to increase access to and quality of\nhealthcare delivery in a cost efficient manner. A mechanistic dominant logic perceives teleconsultation as closely\nresembling the traditional service delivery model, while a CAS dominant logic focuses on the system�s emergent\nbehavior of learning resulting from the relationships and interactions of participating healthcare providers.\nMethods: Qualitative case studies of 17 teleconsultation projects that were part of four health sciences center (HSC)\nbased telemedicine networks was utilized. Data were collected at two points in time approximately 10 years apart.\nSemi-structured interviews of 85 key informants (clinicians, administrators, and IT professionals) involved in\nteleconsultation projects were the primary data collection method.\nResults: The findings indicated that the emergent behavior of effective and sustainable teleconsultation projects\ndiffered significantly from what was anticipated in a mechanistic dominant logic. Teleconsultation projects whose\nemergent behavior focused on continuous learning enabled remote site generalists to manage and treat more\ncomplex cases and healthcare problems on their own without having to refer to HSC specialists for assistance. In\nteleconsultation projects that continued to be effectively utilized, participant roles evolved and were expanded.\nFurther, technology requirements for teleconsultation projects whose emergent behavior was learning did not\nneed to be terribly sophisticated.\nConclusions: When a teleconsultation project is designed with a mechanistic dominant logic, it is less likely to be\nsustained, whereas a teleconsultation project designed with a CAS dominant logic is more likely to be sustained.\nConsistent with a CAS dominant logic, teleconsultation projects that continued to be utilized involved participants\ntaking on new roles and continuously learning. This continuous learning enabled remote site generalists to better\nhandle the constantly changing nature of the problems faced. A CAS dominant logic provides a theoretical framework\nwhich explains why the teleconsultation literature about the role of technology, which is based on a mechanistic\ndominate logic, does not have adequate explanatory power.
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