Socio-Technical Challenges in the Implementation of Telemedicine Regulatory Frameworks. the Italian Case between Health Policies and Practices.

The spread of telemedicine (i.e. ICT-mediated care services) needs to be enabled by the introduction of new health policy regulations, as any innovation must be regulated for efficacy and safety (Kruse et al., 2021). However, the intermingling of knowledge, practices and institutions involved in the relationship between policy and health technologies is always culturally and value-laden, entangled in different power relations, and only seemingly politically neutral (Ashworth & Cloatre, 2022).

This paper aims to analyse how the policy-driven introduction of telemedicine in Italy is challenged by the existence of a 'grey area' where telemedicine may merge with other well-being oriented (albeit non-medical) ICT-mediated services, but also by a number of organisational difficulties, such as the lack of interoperability between different systems and technologies, the weight of territorial and regional mechanisms of path-dependency, and the necessary changes in professional practices to integrate telemedicine into established workflows. These critical issues will be discussed by reviewing the political-institutional approach to telemedicine defined over the last decade in the Italian context, through a documentary analysis of legislation at national and regional levels. The paper will also analyse the most controversial issues related to the obstacles that certain social, economic, technological, cultural and structural factors of the Italian health system represent for the regulatory implementation of ICT innovations. To empirically support this thesis, some case studies of telemedicine services in emblematic Italian healthcare contexts will be presented. They will show how the regulatory and institutional framework can be interpreted, readjusted or overcome by health care providers and health care organisations, producing different socio-technical outcomes.

The aim is to explore the complex relationship between institutional regulation and technological innovation in the health sector, focusing on the socio-technical reasons that often make this relationship problematic and the expected outcomes unfulfilled.