Formation and Resolution of Misfits in a Multi-tiered Telemedicine Consultation Service Platform

Based on the Organization-Enterprise System (Org-ES) fit theory, this thesis conducts a comprehensive investigation into the formation and resolution of various misfits within the telemedicine system context. The telemedicine system is conceptualized as a socio-technical system comprising two interconnected subsystems: the technological system and the social system. This viewpoint recognizes that each telemedicine service involves a multitude of interactions and coordination among individuals and organizations, facilitated by technical platforms. The thesis integrates an organizational perspective with the Chinese telemedicine system using the Org-ES fit theory. The Org-ES fit hypothesis examines fit across four structural levels: physical, surface, deep, and latent structure. In this research, the focus extends beyond individual organizations to inter-organizational dynamics at the fourth-level structure. Geographical proximity emerges as a trigger for challenges in telemedicine due to specific characteristics related to IT avoidance. Moreover, the influence of punishment expectations on inter-organizational relations diminishes over time, while high expectations of rewards prove significant. The National Telemedicine Centre transitions from formal control to social control by fostering inter-organizational bonds, social embeddedness, and a two-way feedback mechanism among users. This thesis contributes to the healthcare information technology literature by offering a nuanced perspective on the telemedicine system as a socio-technical system, exploring misfits and their resolution through the Org-ES fit theory, and emphasizing the role of collaboration and social factors in healthcare information technology implementation. The findings and insights from this research can inform future studies and practical efforts aimed at enhancing the effectiveness and efficiency of telemedicine systems in healthcare settings.