Abstract

SANTOVITO, Riccardo Maria  and  SOUSA, Maria José. Institutionalization of telemedicine: the iTAM-Health structure and evidence from the ULSS3 healthcare system. RISTI [online]. 2025, n.60, pp.34-56.  Epub Dec 31, 2025. ISSN 1646-9895.  https://doi.org/10.17013/risti.60.34-56.

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.

Keywords : Telemedicine; Institutional Trust; iTAM-Health; Sociotechnical Systems; Digital Healthcare Governance.

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