Clinical self-tracking and monitoring technologies: negotiations in the ICT-mediated patient–provider relationship

ABSTRACT

This paper discusses mediation in the patient–provider relationship arising from the introduction of digital technology for a specific form of monitoring: ‘clinical self-tracking’. Focusing on the management of type 1 diabetes, a condition that requires significant self-management by patients, we describe how the actors negotiated a new ICT-mediated relationship in three hospital departments. The analysis followed a qualitative design and was carried out by interviewing patients, clinicians and technology developers and by analysing messages exchanged through the ICT tool. We first show how each department customised the system by drawing on already existing care practices, organisational goals and representations of the department’s desired relationship with the patients. We then focus on patient–provider relationships, showing that, while the clinical self-tracking sometimes followed the path desired by the providers, at other times, it developed in unexpected ways. We distinguish among three emerging categories of self-tracking: self-tracking for remote management, self-tracking for e-learning and self-tracking as boundary setting. The analysis reveals how the new patient–provider relationship arises from an open-ended process. Providers can push self-tracking practices but cannot steer them; and patients, through an unexpected use of the self-tracking technologies, are able to negotiate a desired relationship with providers.

KEYWORDS:

• Clinical self-tracking
• technology-in-practice
• type 1 diabetes
• qualitative analysis
• telemonitoring
• personal health information management

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCiD

Enrico Maria Piras http://orcid.org/0000-0002-6115-0577

Francesco Miele http://orcid.org/0000-0003-1337-9112

Notes

1. Paediatrics: only one physician is in charge of all patients with diabetes. Unlike other departments involved in the trial, the physician does not work with a diabetes nurse, and he manages the system by himself. DC-Adult and DC-Pregnant: patients are assigned to a case manager (nurse) and one or two doctors.

2. Fictitious name.

Additional information

Funding

This work was supported by Department of Health and Social Politics of the Autonomous Province of Trento (Italy) [TreC2 Project].