The relationship between technology and changing professional roles in health care: A case-study in teledermatology.

Technology is often viewed as a way of bringing about change in professional roles in health care. While this was the case in the service that we studied, we would contend that there were organisational and cultural factors that were equally, if not more important. This was a qualitative study, using observation and interviews, of a relatively new service in teledermatology. Traditionally, patients with skin conditions that could not be managed by a primary care physician were referred to a hospital consultant dermatologist, often resulting in long waits for an outpatient appointment. This service replaced that system with referral to a specialist dermatology nurse, working in primary care. The nurses were supported by the option of a teledermatology referral to a hospital consultant, and the service was managed by a consultant nurse. We will discuss the movement in professional boundaries that we observed, how these movements were possible, why they took place, and the role that the technology played in this process.