Infrastructures for Patient-centeredness: connecting Novel and Existing Components to Serve Strategic Agendas for Change

Web-based access to health services, health information and personal health records are increasingly offered to patients for enabling a new, more active patient role. However, incorporating such solutions into national health infrastructures poses challenges. In an information infrastructure perspective, the design of such technologies requires two main intertwined activities: designing ‘the new’ and dealing with ‘the old’ (i.e. the already established infrastructural arrangement). In this paper, we study such activities through the concept of institutional work to investigate how actors go about creating, maintaining and disrupting what was established in provider-centric healthcare. This is investigated in the context of an ongoing national initiative to design and develop a web-based, platform that will support shifting healthcare towards patient-centeredness. Analysing actors’ efforts for “patient authentication”, “availability” and “comprehensiveness”, we identify the pivotal role of activities that are about rearranging seemingly separate technological and institutional components.