Table 1

Application of the Normalization process model to telehealthcare services

Telemedicine intervention

Interactional workability

Relational integration

Skill-set workability

Contextual integration


Video-conferencing system for psychiatric consultations in primary care [37, 91]

Low: poor quality of mediated interpersonal communications interfered with extant frame of professional-patient interaction.

Low: uncertainty about meaning of expressed symptoms and about interpersonal responses undermined embedded trust relations.

Low: uncertainty about how to distribute different modes of teleconsultation across team members from multiple professional groups, including psychologists, nurses and occupational therapists.

Low: added complexity to inter-professional relationships across interface between primary and secondary care. Lack of flexible integration into primary care service delivery.


Remote diagnosis for non-urgent dermatological conditions [7, 92]

Moderate: focus of professional-patient interaction was divided between the apparatus (digital camera) and a computer-driven protocol.

High: trust relations between patients and nurses administering intervention maintained. Trust relations between patients, referring primary care physicians and hospital based dermatologists were undisturbed.

High: intervention was appropriate to nurses administering intervention, and enhanced their skills. It led to specialist nurses operationalizing high level clinical knowledge that overlapped with medical specialists.

Low: service added complexity and workload to specialist physicians. Set up in parallel to existing services it added complexity to the funding, organization and delivery of outpatients' clinics.


Nurse-led home telecare for people with COPD [93, 94]

Moderate: Health professionals and patients are able to communicate effectively. Nurses were concerned about risks attached to distal care of people in danger of sudden exacerbation events.

High: trust relations between patients and nurses remain high. Confidence in service provision across primary-secondary interface is undisturbed.

High: intervention is well suited to provision by specialist nurses.

Moderate: service adds complexity and workload to secondary care.


May BMC Health Services Research 2006 6:86   doi:10.1186/1472-6963-6-86

Open Data