Conceptualizing ‘roles’ in patient- engaging eHealth: an analytical overview of the literature

Two recent reviews have argued that little attention has yet been paid to how eHealth affects roles and responsibilities in healthcare. We present here an alternative review strategy by way of which we may elicit from the existing literature significant insights relating to roles in eHealth. We suggest that the apparent absence reflects an inadequate conceptualization of ‘role’. We conduct a cross-disciplinary literature synthesis to articulate the different ways in which role is conceptualized. Becoming more aware of assumptions and implications related to the concept of role may 1) lead to a renewed appreciation of the contribution of existing literature to help us understand the social and organizational implications of patient-engaging eHealth, and 2) serve as a theoretical contribution leading to increased reflectivity, and more rigorous use, when using the concept of role in relation to eHealth. A deficit in the literature? A recent systematic review of the literature on the implementation of eHealth systems (Mair et al., 2012) suggests that little attention has yet been given to the question of how eHealth systems affect roles and responsibilities in the provision of healthcare. Likewise another review of the literature, on how eHealth affects the relationship between patients and medical professionals (Dedding et al., 2011), argues that more attention should be paid to the redistribution of tasks and responsibility to patients. Granted that the public promotion of eHealth systems to a large extent focus on exactly eHealth’s capacity to redistribute tasks and responsibility to patients, this suggested deficit in the literature is surprising. This type of claimed deficit in the literature is also surprising in another way: In the Science and Technology Studies (STS) literature the social and organizational implications of eHealth systems have been studied intensely for many years and here changes in roles and responsibilities do seem to have been a central concern in many studies (e.g. Langstrup, 2008; Oudshoorn, 2008; Mort et al., 2009; Danholt et al., 2013). Why do the well-known STS findings not find their way into the so-called ‘systematic reviews’? A possible explanation may be that exchanges between different fields of studies, most notably between the biomedical sciences and social science/humanities, can be limited, even when they aim at elucidating similar subjects. However, we wish to suggest that it may also be due to a lack of reflection on the very conceptualization of roles. In this paper we wish to explore and challenge the often taken-for-granted use of the concept of roles.