Alignment of concerns: A design rationale for patient participation in eHealth

The emergence of patient-centered eHealth systems introduces new challenges, where patients come to play an increasingly important role. Realizing the promises requires an in-depth understanding of not only the technology, but also the needs of both clinicians and patients. However, insights from medical phenomenology bring forth how physicians and patients focus on different aspects of illness and that they often have starkly divergent concerns. This has important implications for the design of eHealth systems that seek to engage patients as active participants. We emphasize the crucial importance of acknowledging these fundamental differences between patients' and physicians' everyday projects and we illustrate it by three case examples from a participatory design project of constructing a personal health record for chronic heart patients and their clinicians. We summarize our suggestion as a design rationale for successful eHealth, termed 'alignment of concerns'.