Aligning Concerns in Telecare: Three Concepts to Guide the Design of Patient-Centred E-Health

The design of patient-centred e-health services embodies an inherent tension between the
concerns of clinicians and those of patients. Clinicians’ concerns are related to professional issues to do
with diagnosing and curing disease in accordance with accepted medical standards. In contrast, patients’
concerns typically relate to personal experience and quality of life issues. It is about their identity, their
hopes, their fears and their need to maintain a meaningful life. This divergence of concerns presents a
fundamental challenge for designers of patient-centred e-health services. We explore this challenge in
the context of chronic illness and telecare. Based on insights from medical phenomenology as well as
our own experience with designing an e-health service for patients with chronic heart disease, we
emphasise the importance – and difficulty – of aligning the concerns of patients and clinicians. To deal
with this, we propose a set of concepts for analysing concerns related to the design of e-health services:
A concern is (1) meaningful if it is relevant and makes sense to both patients and clinicians, (2)
actionable if clinicians or patients – at least in principle – are able to take appropriate action to deal
with it, and (3) feasible if it is easy and convenient to do so within the organisational and social context.
We conclude with a call for a more participatory and iterative approach to the design of patient-centred ehealth
services.