Abstract
Background: Telehealth initiatives have bloomed around the globe, but their integration and diffusion remain
challenging because of the complex issues they raise. Available evidence around telehealth usually deals with its expected
effects and benefits, but its unintended consequences (UCs) and influencing factors are little documented. This study
aims to explore, describe and analyze multidimensional UCs that have been associated with the use of telehealth.
Methods: We performed a secondary analysis of the evaluations of 10 telehealth projects conducted over a 22-year
period in the province of Quebec (Canada). All material was subjected to a qualitative thematic-pragmatic content
analysis with triangulation of methodologies and data sources. We used the conceptual model of the UCs of health
information technologies proposed by Bloomrosen et al to structure our analysis.
Results: Four major findings emerged from our analysis. First, telehealth utilization requires many adjustments, changes
and negotiations often underestimated in the planning and initial phases of the projects. Second, telehealth may result
in the emergence of new services corridors that disturb existing ones and involve several adjustments for organizations,
such as additional investments and resources, but also the risk of fragmentation of services and the need to balance
between standardization of practices and local innovation. Third, telehealth may accentuate power relations between
stakeholders. Fourth, it may lead to significant changes in the responsibilities of each actor in the supply chain of
services. Finally, current legislative and regulatory frameworks appear ill-adapted to many of the new realities brought
by telehealth.
Conclusion: This study provides a first attempt for an overview of the UCs associated with the use of telehealth.
Future research-evaluation studies should be more sensitive to the multidimensional and interdependent factors that
influence telehealth implementation and utilization as well as its impacts, intended or unintended, at all levels. Thus, a
consideration of potential UCs should inform telehealth projects, from their planning until their scaling-up.