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Telecaring Philosophical and empirical studies of human-technology relations Finn Olesen Department of Information & Media studies Aarhus University, Denmark

Headlines • • •

What is (technological) mediation? A vague, general definition of technological mediation Telecare praxis as subject to philosophical enquiry

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Telemedicine Diagnosis, treatment, and monitoring, with health professionals (and patients) separated by space (and often time) and mediated through ICT devices Digital transmission of medical images and health data from site to site

Challenge: lack of specialists in the future; longer physical distances to treatment and hospitals Possibility of „second opinion‟ from a specialist from a remote health center Potential decrease of hospitalisations, and expected care improvement

Tele(home)care • „Telecare‟, or telehomecare‟, usually refers to the idea of offering remote, person-centered care, e.g. to old or physically less able people.

• The intended aim is to provide patients with sufficient care and reassurance to allow them to remain living independently in their own homes

Techno-mediated understanding of healthcare? • Telemedical communication and interactions between doctors, nurses and patients are marked by technological mediation:

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patients<>telemedical devices<>health professionals

How can this „effect‟ or „addition‟ be studied and described? What is (technological) mediation?

Instrumental approach â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

A dominant notion: something is being moved by technological tools, eg. words, visual images, numbers, or being assisted by it, e.g. communication, work processes Telemedicine is a neutral tool to be used by rational human agents in a well-defined practical context for planned ends The succes or failure of this technological solution to a healthcare issue depends on the design quality of the system and the skills and motivations of the human participants

How do we spot techno-logical mediations? • Bruno Latour: •“Why is it so difficult to measure, with any precision, the mediating role of techniques? Because the action that we are trying to measure is subject to “blackboxing”, a process that makes the joint production of actors and artifacts entirely opaque.” („On Technical Mediation‟ p. 36)

•Technological mediations happen in opaque arrangements of actions. Hence, we must look for indirect signs of mediations

Diffusion vs. Translation

Diffusion model

‣There is some original power, e.g. expertice, which causes the distribution of technology ‣There is an initial inertia, which remains stable during the whole process of distribution ‣Social agents may work against or support the distribution ‣Distribution of technology = transmission

Translation model ‣All actors translate technology to fit their own projects and interests ‣What is being sent on to the next link in a chain of relations is not „the same‟ as the original intention or plan ‣The fate of technological systems or devices is in the hands of later users (who also change in the process) ‣Distribution of technology = transformation Bruno Latour

Preliminary thesis

â&#x20AC;˘ Technological mediation is not a neutral homogeneous thing or process, rather it denotes a multible palette of interactions between heterogenous agencies and realities

â&#x20AC;˘ Hence, do not talk about what technological mediation is. Ask instead which heterogenous sociotechnical arrangements help bringing about a particular (kind of) situated relationship

From Garden to Earth • Don Ihde:

•“It is the knowledge born of difference of variations which holds the secrets to a world both wider and less innocent than Adam‟s. But just as the very familiarity with our Adamic dimension may be left unexamined and undiscerned, so too can both the quality of our mediated relation to the world and its difference from our naked relation to the world. To examine both mediation and its difference is to enter the phenomenology.” (Technology and the Lifeworld, p 46)

How do we examine such difference of variations?

Postphenomenologic al analysis â&#x20AC;˘ Don Ihde: A phenomenological analysis of relations between humans and technology must have as a goal to point out some patterns in such relations

â&#x20AC;˘ Especially patterns in perceptual possibilities and limitations

Technological mediation

• Technological mediation

is not about how technology mediates between independent, pre-existing subjects and objects It is about the mutual coconstitution of subject and object in a praxis (Ihde, Verbeek) Mediation is about

Amplificationreduction â&#x20AC;˘Amplification of one aspect of reality through technomediated perception often involves a reduction of other perceptions of the world

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COPD Sygehus Fyn test Patients get the briefcase 24 hours after discharge from hospital for 7 days Daily contact with specialist nurse via telecare system (three-button interface) Self-measurement of blood saturation, spirometry (peak flow & volume), pulse Instructions and evaluation from nurse

Project manager Anne Sorknæs, specialist nurse and phd student

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Empirical study Both quantitative and qualitative study postphenomenological analysis Qualitative study of the experiences of patients and nurses with use of telecare consultations 8 patients and 8 nurses were included in study Field work: observing nurses and patients during tele consultancies; individual and focus group interviews, video and voice recordings

Changing patterns •Interactions on the screen and a new foundation for making decisions:

from whole-bodied perception in physical proximity to digital proximity - perception mediated through patient briefcase (Oudshoorn)

•New patterns: • •

(nurse - patient briefcase) - patient and vice versa nurse - (patient briefcase - patient) and vice versa

Changing patterns •

In general:

• the interlocutor appears as a „torso‟ in

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„face-to-face‟ interactions smelling and touching is not applicable to the professional evaluation made by the nurses, only audio-visual sensing applies new kinds of follow-up on health condition, care and treatment

Mediation of nursing role

•Telecare nursing is more about observing and communicating than in the ward:

“You have to be a lot more conscious about the words you choose to explain it with, perhaps more thorough than we are when the patient is present to us” “The patients must actually be able to transform words into actions” Nurses compensate for lack of physical proximity by using language and gestures to create digital proximity

Transformations •

Reduction af proximal sensing: touching and smelling, leads to amplification of distal sensing: seing and hearing:

•“Well, I would say that precisely because I cannot see what is going on down on the surface of the table, I use my ears a lot ... and for that I find that the device, we have out at the patient, is really good because there are different sounds to the buttons they press. So I use them a lot to hear if they press correctly, or if they press too long, so that they get into the coding of the device, or if they get it started, so it is ready for the measuring we are about to make. I think that works really well. It is quite clear that ... if I could not hear that device ... then it would have been difficult to work with, because I can‟t

The patient as • assistent

The patient is co-producer of data, is trained as an „assistent‟ to the nurses, and is partly responsible for checking lung functions, pulse readings, blood saturation, dispatching measurement results, technical functionallity

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In general, the patients manage the new responsibilities, and the nurses work out ways to instruct patients in the tele-based environment The legal, psychological and moral significance of this shared responsibility is not clear

Preliminary thesis revisited â&#x20AC;˘ Technological mediation is not a homogeneous thing or process, rather it denotes a multible palette of interactions between heterogenous agencies and realities

â&#x20AC;˘ Hence, do not talk about what technological mediation is. Ask instead which heterogenous sociotechnical arrangements help constituting particular (kinds of) situated relationships

Future studies â&#x20AC;˘ Study more reconfigurations of patientprofessional relationships due to technological mediations

â&#x20AC;˘ In the process technological mediation is both intervening as moderation and bringing about new knowledge, actions, responsibilities, competencies, roles, identies, etc. - why, how and where?

â&#x20AC;˘ Telecare, health professionals and patient are thus always in the making; stabilities are not pre-given, but some


Finn Olesen, 2nd X-Change Lab