The role of industry infrastructure in telehealth innovations: a multi-level analysis of a telestroke program

The information-intensive nature of the healthcare industry and the potential of information technology (IT) to reduce costs and improve quality of services have increased the focus on IT-based innovations. Yet, our ability to understand and manage how IT-based innovations unfold in the context of healthcare is still limited. In this paper, we apply Van de Ven's industry infrastructure framework to investigate a telehealth innovation that provides remote medical assistance to stroke patients in a network of collaborating hospitals. The resulting multi-level analysis contributes to understanding the innovation by revealing a highly complex process of interactions between key stakeholders and healthcare industry infrastructure. Despite the innovation's strong potential, the process is mainly push-driven with minimal pull from potential adopters. Moreover, the push is created by a small group of medical innovators with limited technological and financial resources and little infrastructural support. The study contributes with contextual insights into the telehealth innovation, suggesting complementary explanations of why the healthcare industry despite considerable investments continues to lag behind other industries in adoption of IT-based innovations. The study also adapts Van de Ven's framework by applying it to a single case of innovation rather than as originally conceived to several instances of an innovation within an industry. The analysis shows how some of the components of the framework were adapted to and interpreted in the context of telehealth innovations.