Negotiating Professional Knowledge and Responsibility in Cross-sectoral Telemedicine1

Abstract

In ongoing efforts of rationalization and retrenchment in the Danish health care sector, tasks are increasingly moved from costly specialized hospital departments to the primary health care sector, where less specialized personnel take on these tasks. Telemedicine plays an important role in facilitating local access to specialized competences at central hospitals through ICT systems and establishes new virtual spaces for cross-sectoral cooperation between hospital and municipal health care workers. In an explorative ethnographic study, comprising interviews and participant observation, of telemedicine-based interaction between community nurses and specialized hospital nurses, we show how the ‘tele-ulcer' system becomes a site for professional development for community nurses, although a hierarchization of professional knowledge also takes place. Furthermore, extensive articulation work is necessary to make the tele-ulcer system work. We illuminate how contradictory divisions of responsibility may result from the design of the sociotechnical system, leaving professionals to deal with risks and insecurity.