Spatial Diffusion of Telemedicine in Sweden

Sammanfattning: “Telemedicine” denotes medicine at a distance using telecommunications and information technologies. The aim of the thesis is to reveal determinants and outcomes of telemedicine diffusion—that is, the spread of telemedicine in time and space. Telemedicine is examined both at the national level and in a regional case study. At the national level, quantitative methodology is utilized to analyze the emergence of health care facilities using telemedicine to receive medical assistance. The regional case study examines the diffusion and outcomes of telemedicine networks in Northern Sweden based on non-quantitative data sources.The first telemedicine applications in Sweden emerged between hospitals in southern Sweden in the 1970s. It was in the 1990s, however, that the practice of telemedicine took off on a larger scale. By the year 2000, the number of remote sites was quite evenly distributed across the country and between specialist and primary care facilities. In northern Sweden, telemedicine was first implemented in the mid-1980s, and is now carried out in all counties in the region. The telemedicine networks in northern Sweden primarily concern teleradiology, general telemedicine, and telepathology. Commonly, telemedicine is carried out within counties in hierarchical hub and spoke-type networks connecting specialist and primary care facilities.The study shows that existing telemedicine facilitates its further diffusion at the regional level, but shows a lack of the obvious neighborhood effect that could be expected in light of many previous diffusion studies and geographical diffusion theory. The health care system in Sweden is characterized by a high degree of regional autonomy. Contacts between medical staff, and thus dissemination of information and opinions concerning telemedicine, are therefore likely to be more prevalent within than between the regional health care organizations. The health care organizations are also decision-making bodies with different telemedicine policies. In addition, already implemented telemedicine programs tend to expand within the health care organization in which they originated.Although no traditional neighborhood effect to speak of can be noticed in Swedish telemedicine diffusion, distance matters in the diffusion process in a quite different respect. The study shows that health care facilities located far from more specialized care are especially likely to adopt telemedicine. Another local factor, facility size, is also positively correlated with telemedicine diffusion. This correlation between facility size and telemedicine adoption, as well as the circumstance that the diffusion process started with, and has progressed the furthest in, specialist care, suggest that the diffusion of telemedicine exhibits hierarchical characteristics.The development of telemedicine technology significantly influences the rate of telemedicine diffusion. In a simulation of the diffusion process, it is shown that—given that computers and information technology continue to develop according to the present trend—there will be a significant increase in the number of primary care facilities functioning as remote telemedicine sites during the first decade of the 21st century.