## 3 Results and Discussion
### Organizational Practice as a Challenge for Access to Knowledge  
In this article we analyze the contradiction between the need for knowledge-sharing through VC technology as well as the reasons for the low frequency of its use for discussing stroke patients. The results illustrate how the technology _per se_ is not the reason for the low frequency use of VC. We argue for analyzing technology in practice not according to single problems, but according to the stroke treatment activity as a whole. Further, we analyze the use of VC as a tool for the treatment of stroke patients, where the outcome is seen as individual stroke treatment, sharing knowledge between the local and the specialist hospital. We are searching for reasons for the low frequency of use, which demands analyzing the activity--here, the referring hospital--as an activity system. The patient arrives as an acute case, where time is critical. When the patient arrives, the intern is the one who evaluates the patient's condition. This is the first contradiction in the activity: considering following standard rules for thrombolic treatment, or discussing every case individually. The work is organized so that the intern is the one deciding if the patient is a candidate for thrombolic treatment, or if the second call on duty should be contacted. This is the second contradiction between the division of labor and the subject, in this case the intern. If the intern wants to discuss the patient, or decides to give thrombolic treatment, the second call on duty is contacted. Here, the third contradiction is between the tool and the institutional rules for stroke treatment. They follow the use of the VC technology for discussing stroke patients relatively strictly. If the patient is not a candidate for thrombolic treatment, they do not use the VC equipment. If the rules for giving thrombolic treatment are fulfilled, they use VC as a tool for obtaining approval or a second opinion for giving or not giving the treatment. Health care is shaped by behavior, traditional rules, standards and division of labor. In this case, the reason for low frequency use may be explained by constant reproduction of the activity. The use of VC for stroke, often referred to the use of telemedicine, in its nature conflicts with traditional routines and the way of performing daily work practice. An activity system, such as a hospital, produces a large number of actions, often repeated with small variations. Over time, actions become automatic, as routines. Each phase in the stroke consultation may be seen as an action situation, where each action is shaped by, and in turn gives shape to, the historically evolving structure and contradictions of the entire activity system. Medical cognition is a collaborative achievement between the professionals at the referring hospital. The interns use the procedures as a tool to manage their problems, or search for the second call on duty. The second call on duty traditionally uses the telephone to discuss medical problems. In this sense, Norwegian health care is deeply rooted in traditional ways of performing treatment. To reach the potential of telemedicine, and for knowledge-sharing, professionals must change the traditional way of performing and thinking medical practice. We argue that to fulfill the national goal to provide more patients with thrombolic treatment, cases of stroke patients where the indications are blurred need to be discussed. In a CHAT perspective, each activity system has its own motives for a particular outcome. Both interns and the physicians may aim to fulfill the goal of giving thrombolic treatment, following rules for such treatment. Changing the motive for the action from giving thrombol treatment to knowledge-sharing between professionals for improved stroke treatment may change the use of VC technology as a tool. Here, the motive is visual collaborative work, emphasizing the opportunity to see the situation, instead of the telephone's capability to only hear a professional's descriptions of stroke patients.