Informed Collaboration in Health Care: An Embedded‐Cases Study in Geriatric Telepsychiatry

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Telemedicine, the delivery of medical consultation and services, is enabled by information and communications technologies. Participants in telemedicine consultation services (ie, clinicians, patients, and other parties) use video conferencing, special‐purpose software and/or hardware, and data and notes from electronic medical records and other systems to formulate effective treatment plans. Telemedicine is a particular mode of informed collaboration—information and communications technology–supported collaborative activity in which collaborators rely (wholly or in part) on digitally stored information retrieved from various sources to pursue their collective objectives. We report on an embedded‐cases study of a long‐running geriatric telepsychiatry clinic in the north‐eastern United States. Our analysis draws on the theory of distributed cognition (DCog) to explicate the ways in which information and cognitive effort are distributed across individuals and artefacts to support psychiatric consultation from a distance and how these processes play out over time in routines. On the basis of this case study, we offer a refinement of DCog theory, focusing on four interrelated dynamic processes that, we propose, act as critical enablers of informed collaboration: cognitive offloading, visibility of action, intersubjective understanding, and knowledge redundancy. We discuss practical implications for designing telemedicine services and tools, and we offer suggestions for further research on informed collaboration.