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Integrating service development with evaluation in telehealthcare: an ethnographic study

BMJ 2003; 327 doi: (Published 20 November 2003) Cite this as: BMJ 2003;327:1205
  1. Tracy Finch (Tracy.Finch{at}, senior research associate1,
  2. Carl May, professor of medical sociology1,
  3. Frances Mair, professor of primary care research and development2,
  4. Maggie Mort, senior lecturer3,
  5. Linda Gask, reader in community psychiatry4
  1. 1Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 3DN
  2. 2Department of Primary Care, University of Liverpool, Liverpool L69 3GB
  3. 3Institute of Health Research, Lancaster University, Lancaster LA1 4YJ
  4. 4School of Primary Care, University of Manchester, Manchester M14 5NP
  1. Correspondence to: T Finch
  • Accepted 8 October 2003


Objectives To identify issues that facilitate the successful integration of evaluation and development of telehealthcare services.

Design Ethnographic study using various qualitative research techniques to obtain data from several sources, including in-depth semistructured interviews, project steering group meetings, and public telehealthcare meetings.

Setting Seven telehealthcare evaluation projects (four randomised controlled trials and three pragmatic service evaluations) in the United Kingdom, studied over two years. Projects spanned a range of specialties—dermatology, psychiatry, respiratory medicine, cardiology, and oncology.

Participants Clinicians, managers, technical experts, and researchers involved in the projects.

Results and discussion Key problems in successfully integrating evaluation and service development in telehealthcare are, firstly, defining existing clinical practices (and anticipating changes) in ways that permit measurement; secondly, managing additional workload and conflicting responsibilities brought about by combining clinical and research responsibilities (including managing risk); and, thirdly, understanding various perspectives on effectiveness and the limitations of evaluation results beyond the context of the research study.

Conclusions Combined implementation and evaluation of telehealthcare systems is complex, and is often underestimated. The distinction between quantitative outcomes and the workability of the system is important for producing evaluative knowledge that is of practical value. More pragmatic approaches to evaluation, that permit both quantitative and qualitative methods, are required to improve the quality of such research and its relevance for service provision in the NHS.


  • Contributors CRM, MM, FSM, and LG conceived and designed the study. TLF led the fieldwork and analysis, to which all authors contributed. TLF and CRM drafted the paper, and all authors contributed to revision and approved the final version. TLF is guarantor for the study.

  • Funding Department of Health (grant ICT/032); Economic and Social Research Council (grant L L218 25 2067).

  • Competing interests None declared.

  • Ethical approval The study was approved by Central Manchester Ethics Committee and Northern and Yorkshire Multi Centre Research Ethics Committee. 2003;327:1205

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