Changing Perspectives on Informatics? - A Comparison of Three National Electronic Health Records

Participatory approaches to health care are getting increasingly popular in Western countries. But are the perspectives on informatics changing as well? Because not every patient (always) can or wants to actively participate in his health care process, differentiation in medical encounters is needed. We use the term ‘‘relational responsibility’’ to refer to a process in which doctor and patient are responsive to each other’’s norms, values and ideas, especially with respect to their role division. Health informatics can support or restrict this differentiation by giving patients access to Electronic Health Records (EHRs) and/or converging those records with Personal Health Records (consumer oriented informatics). When we look at the policies on the national EHRs in Canada, Denmark, and The Netherlands we find that the orientation towards informatics is still mainly provider-oriented. Even when policy makers emphasize the importance of patient participation and are aware of the potential of health informatics in this context, they have not given priority to translating this into the design of their EHR. This means that for the upcoming years EHRs will support one traditional role division: the one in which the health care professional is in the lead and is the better-