This study followed the development of a multidisciplinary medical team meeting (MDTM) through changes that incorporated teleconferencing technology and a picture archive and communication system (PACS). Using both qualitative and quantitative data, MDTMs are shown make health services safer for patients. Analysis of screen displays, speech, and observations reveals the dynamics of MDTMs. System boundaries extend beyond the actual meeting. Stable work routines, timing and rhythms, are critical for success. Changes in organization structures, positive and negative, are demonstrated because of teleconferencing. Discussion structure is stable but speech dynamics are affected, and it takes much longer to describe images in teleconference. Teleconference discussions take more time and are considered less satisfactory from the users' perspective although improvement in information quality is evident. There is an important requirement for visual displays at MDTMs and visual support for all participants is emphasised. These results have implications for the design of future systems and the implementation of new channels of communication within the health service.

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