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

In Sweden, as in many other European countries, government and public agencies have
promoted the expansion of eHealth over the past years, arguing that this development
enhances patient participation, empowerment and cost efficiency. This paper presents a
longitudinal study of the deployment of My medical records 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 norms, dictating access and use. These norms are in turn
shaped by both social and legal norms as well as 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.