When patient empowerment encounters professional autonomy: The conflict and negotiation process of inscribing an eHealth service

Abstract

In Sweden, as in many other European countries, government and public agencies have promoted the expansion of eHealth in recent years, arguing that this development enhances patient participation, empowerment and cost efficiency. This article presents a study of the development of My medical record on the Internet, a civic service originally inspired by the home banking concept. The study illustrates how the technology is developed and inscribed with new technical norms, dictating access and use. These norms are in turn shaped by negotiations between social and legal norms as well as the values and beliefs of several different actors involved in the development process. Supported by the study, we conclude: 1) that the new technology challenges the medical professionals, thus causing resistance as the institutional boundaries are changed when patients are given digital access to their medical record; 2) that the technology changes or inscribes the law; 3) that a pilot project of this type is dependent on an enthusiast, seeing the project through until it becomes accepted on a larger scale; and 4) that increased patient participation requires improved access to information which differs from the NPM rhetoric advocating more service to customers.