The global pandemic has escalated the demand for telemedicine systems across the world, particularly for vulnerable populations such as the elderly in nursing homes. However, challenges in implementation and high failure rates continue to affect the sustainability and capability of telemedicine systems. This study therefore addresses the question of how to sustain and develop telemedicine systems, and offers a conceptual model developed from longitudinal study data and paradox theory. We found that in the inter-organizational context of telemedicine systems, paradoxical tensions arise from conflict between demands and interests of the telemedicine system versus those of its members. We also identified when the specific tensions of belonging, learning, organizing, and performing are likely to occur. These tensions are addressed through responses, initiated by the hub, that address both system and member level demands and interests through creating collaborative governance, uplifting member capabilities, and targeted resourcing. We further demonstrate the temporal dynamics of how the hub's responses create inter-organizational norms and structures that in turn influence responses to tensions in subsequent phases. We examined variations in members' reactions to the responses, and found that they were influenced by member-specific resource factors, suggesting that while the hub does sustain the development of the telemedicine system through addressing common member demands, there are limits with regard to aspects that are more member-specific. Finally, we show how technology can be both enabler-trigger and enabler-response due to its inherent attributes of malleability and reconfigurability.

全球大流行增加了世界各地对远程医疗系统的需求，特别是对养老院中的老年人等弱势群体。然而，实施方面的挑战和高故障率继续影响远程医疗系统的可持续性和能力。因此，本研究解决了如何维持和发展远程医疗系统的问题，并提供了一个从纵向研究数据和悖论理论发展而来的概念模型。我们发现，在远程医疗系统的组织间背景下，矛盾的紧张关系源于远程医疗系统与其成员的需求和利益之间的冲突。我们还确定了何时归属感、学习、组织和表演的特定张力很可能会发生。这些紧张关系是通过由中心发起的响应来解决的，通过创建协作治理、提升成员能力和有针对性的资源配置来解决系统和成员级别的需求和利益。我们进一步展示了枢纽响应如何创建组织间规范和结构的时间动态，进而影响对后续阶段紧张局势的响应。我们检查了成员对响应的反应的变化，发现它们受到成员特定资源因素的影响，这表明尽管中心确实通过解决共同的成员需求来维持远程医疗系统的发展，但在某些方面存在限制更具体的成员。