Electronic Health Records Are More Than a Work Tool: Conflicting Needs of Direct and Indirect Stakeholders

The involvement of stakeholders is crucial when designing IT in highly complex application domains, such as healthcare. Stakeholder relationships are complex and can include strongly conflicting needs and value tensions. In this case study, we investigate the different perspectives of patients and physicians related to Patient Accessible Electronic Health Records (PAEHR) in Sweden. Generally, the introduction of this service has been heavily criticised by healthcare professionals, but welcomed by patients. The paper presents an innovative study design where themes from interviews with physicians are used as a lens to analyse survey data from patients. The findings highlight the necessity to understand stakeholders' perspectives about other stakeholder groups by contrasting assumptions and expectations of physicians (indirect stakeholders) with experience of use by patients (direct stakeholders), and discusses practical challenges when designing large-scale health information systems.