<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-9895</journal-id>
<journal-title><![CDATA[RISTI - Revista Ibérica de Sistemas e Tecnologias de Informação]]></journal-title>
<abbrev-journal-title><![CDATA[RISTI]]></abbrev-journal-title>
<issn>1646-9895</issn>
<publisher>
<publisher-name><![CDATA[AISTI - Associação Ibérica de Sistemas e Tecnologias de Informação]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-98952025000400034</article-id>
<article-id pub-id-type="doi">10.17013/risti.60.34-56</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Institucionalização da telemedicina: a estrutura iTAM-Health e evidências do sistema de saúde ULSS3]]></article-title>
<article-title xml:lang="en"><![CDATA[Institutionalization of telemedicine: the iTAM-Health structure and evidence from the ULSS3 healthcare system]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santovito]]></surname>
<given-names><![CDATA[Riccardo Maria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[Maria José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Università Ca&#8217; Foscari Venezia Venice School of Management ]]></institution>
<addr-line><![CDATA[Venezia ]]></addr-line>
<country>Italy</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,ISCTE - University Institute of Lisbon Business Research Unit (BRU-IUL) ]]></institution>
<addr-line><![CDATA[Lisboa ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<numero>60</numero>
<fpage>34</fpage>
<lpage>56</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-98952025000400034&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-98952025000400034&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-98952025000400034&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo A adoção da telemedicina nos sistemas públicos de saúde é um processo complexo, moldado por dinâmicas institucionais, organizacionais e relacionais mais do que pela tecnologia. Este estudo investiga os mecanismos que influenciam a confiança, a utilidade percebida, a facilidade de uso, as condições facilitadoras e a eficiência na implementação da telemedicina, aplicando o modelo iTAM-Health e uma lente realista crítica ao caso ULSS 3 Serenissima (Véneto, Itália). Utilizou-se um desenho qualitativo de múltiplas fontes, incluindo entrevistas com chefes de cardiologia, análise documental e triangulação empírica. A codificação assistida por IA identificou quatro mecanismos geradores: (1) estabilização normativa; (2) alinhamento sociotécnico; (3) valorização funcional; e (4) feedback institucional. Os resultados mostram a adoção como um ciclo coprodutivo no qual tecnologias e instituições se reforçam mutuamente. A integração entre iTAM-Health e realismo crítico oferece uma estrutura para compreender e governar a saúde digital com foco em sustentabilidade, valor público e responsabilidade institucional.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract The adoption of telemedicine in public healthcare systems is a complex and multilayered process shaped less by technology than by institutional, organizational, and relational dynamics. This study examines the mechanisms influencing trust, perceived usefulness, perceived ease of use, facilitating conditions, and efficiency in the implementation of telemedicine, applying the iTAM-Health model and a critical realist lens to the case of ULSS 3 Serenissima (Veneto, Italy). A multi-source qualitative design was used, including interviews with cardiology department heads, document analysis, and empirical triangulation. AI-assisted coding identified four generative mechanisms: (1) normative stabilization; (2) sociotechnical alignment; (3) functional valorization; and (4) institutional feedback. Findings show adoption as a co-productive cycle in which technologies and institutions mutually reinforce each other. The integration of iTAM-Health with critical realism offers a comprehensive framework to understand and govern digital health as an ecosystem grounded in sustainability, public value, and institutional accountability.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Telemedicina]]></kwd>
<kwd lng="pt"><![CDATA[Confiança Institucional]]></kwd>
<kwd lng="pt"><![CDATA[iTAM-Health]]></kwd>
<kwd lng="pt"><![CDATA[Sistemas Sociotécnicos]]></kwd>
<kwd lng="pt"><![CDATA[Governação da Saúde Digital]]></kwd>
<kwd lng="en"><![CDATA[Telemedicine]]></kwd>
<kwd lng="en"><![CDATA[Institutional Trust]]></kwd>
<kwd lng="en"><![CDATA[iTAM-Health]]></kwd>
<kwd lng="en"><![CDATA[Sociotechnical Systems]]></kwd>
<kwd lng="en"><![CDATA[Digital Healthcare Governance]]></kwd>
</kwd-group>
</article-meta>
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