Cooperation versus coordination: using real-time telemedicine for treatment at home of diabetic foot ulcers.

In conventional treatment the patient with a diabetic foot ulcer travels to hospital for consultations with the experts. We conducted an organizational analysis of the cooperation taking place when telemedicine was used for treatment at home instead. In a pilot study, five patients were offered three video consultations in their home, replacing visits to the outpatient clinic. The equipment consisted of mobile videophones and an online ulcer record. The introduction of simultaneous communication between all participants solved the problem of the patient having to act as messenger between the hospital and the visiting nurse; there were other benefits as well. However, this new organization required increased efforts for coordination and may have incurred extra costs in the case of delays. Thus when designing telemedicine systems, the goal should be to facilitate the coordination and lower the barriers to real-time communication, but at the same time provide mechanisms for asynchronous communication in situations where synchronous communication is not possible. [ABSTRACT FROM AUTHOR]