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Danish citizens' attitudes and expectations to eHealth is being investigated in this paper with the aim is to explore how the Danish citizens perceive eHealth. Data has been collected through a national survey with 1.058 respondents (80% participated by e-mail, 20% by telephone). We found that the majority of the Danish citizens had experience with use of eHealth and a positive view on eHealths impact on future healthcare. However, the citizens neither using nor trusting eHealth, belong to the socio-economic weak population with no or very little education suggesting a need for the designers and planners to revisit their patient empowerment strategies.

The aim of this paper is to identify characteristics of patients' contributions to innovation in health information technology (HIT). The paper outlines a theoretical definition of patient innovation and presents an analysis of four digital prototypes and 22 low-fidelity mock-ups designed by people affected by the chronic illness diabetes mellitus. Seventeen families (a total of 60 people) with one or more diabetic family members participated in design activities in a four-year research project focused on the design of digital support for everyday living with diabetes. Our analysis documented the originality of the analysed patient designs and identified three characteristics of patients' designs: socio-technical networks, objects with associated personal meanings and technology supporting the expression of identity. The paper concludes that patient innovation is defined by what is perceived as new by patients and/or others within the social system of adaptation. The analysed patient designs are original (as distinct from replications of or improvements on known products), and their characteristics are innovative contributions to the social system of everyday living with diabetes (i.e. they are perceived as new to the patients in the research study). The results of the analysis contribute to the credentials of patients as key actors in HIT innovation and call for participatory approaches in health informatics.

This chapter discusses the complementary role of Techno-Anthropological methodologies in relation to classical quantitative and qualitative methodologies. The chapter addresses the importance of evidencing the problems in health informatics and how these problems are framed in order to find appropriate solutions. It is the claim that problem based learning approaches (PBL) and inter-disciplinary teamwork is paramount in order to meet the current challenges of development and implementation of health informatics in the health care system. The triple aim of providing better health, better care at lower cost on a societal level is complemented by similar aims on an institutional and individual level in order to frame health informatics on a more holistic level. In order to achieve this goal we have to embrace concepts like co-creation and co-construction with users and actors. The aim of the chapter is condensed in methodological recommendations for Techno-Anthropological work in health informatics contexts.

The success of information technology (IT) in transforming healthcare is often limited by the lack of clear understanding of the context at which the technology is used. Various methods have been proposed to understand healthcare context better in designing and implementing Health Information Systems. These methods often involve cross-sectional, retrospective data collection. This paper describes the postcard method for prospective real-time data collection, both in paper format and electronic format. This paper then describes the results obtained using postcard techniques in Denmark and Australia. The benefits of this technique are illustrated. There are limitations in using postcard techniques and this paper provides a detail discussion about these limitations. Postcard techniques provide unique advantages in understanding real time healthcare context and it is an important technique to consider in IT design and implementation in healthcare.

Experience shows that the precondition for development of successful health-information-technologies (HIT) is a thorough insight into clinical work practices. In contemporary clinical work practices, clinical work and health information technology are closely integrated. Research within Virtual Centre for Health Informatics at Aalborg University, Denmark have during recent years focused on video observation to supplementing traditional ethnographical research methods in providing insight into complex clinical work practices. The objective of this paper is to argue for the potentials of the video observation method to inform and to improve HIT development compared to traditional ethnographic methods. Based on several studies conducted within the healthcare sector, we find, that the video observation method is superior to other ethnographical research methods when it comes to rapidly disclosing the complexity in clinical sociomaterial work practices. We also find that the video techniques used in the healthcare context allows us to revisit the field of observation through the data, to broaden our initial focus and to share data with both the clinical staff involved and other researchers. Hence, it provides us a more in depth insight in the complex clinical sociomaterial work practices than when observing by the use of pen and paper.

A well-known challenge in system development is the aspect of user participation. In this paper we shift perspective from how to involve users in system development to how project managers with a clinical background, but without technical system knowledge, can involve system developers in IT projects. Using data from the development of an online patient book (an ICT application for clinical practice), we analyze challenges using the concept of language-games. We conclude that further research and development of participatory and communicative methods to involve system developers in IT projects, based in a clinical context, is needed.

Experience shows that to achieve a successful implementation of EHR clinicians must obtain joint ownership of the decisions made during the EHR-process. The EHR planning process in the Region of North Jutland, Denmark was studied with the aim of answering the question; "Why are not all Danish physicians overjoyed by the introduction of EHR? A case study was carried out from Oct. 2003 till April 2006 using process analysis. The EHR project management's strategy meant that there was no workload reduction. This was seen as one of the main barriers for the physicians to achieve real influence. History shows that clinician's on the one hand and administrators on the other have different perceptions of the purpose of the patient record and that they both have struggled to influence this definition. To date, the administrators have won the battle. This was the major reason for the approach chosen for the EHR planning process in North Jutland, Denmark. It explains the conditions made available for the physicians, which led to their role being reduced to clinical consultants--rather than real participants.

The purpose of this study is to establish a foundation for participatory design between Information Technology (IT) professionals and people with chronic diseases resulting in IT-supported compensation in daily life. The paper presents the methods applied and results from a qualitative study to understand everyday life with diabetes. The participants are 8 families with one or more diabetic member. Our analysis outlines perspectives, activities, locations and information related to daily life with diabetes. On the basis of the analysis a number of artifacts are designed and tested in a living lab environment in Skagen, Denmark. It is concluded that participatory design and the use of the living lab concept yielded a richness of data adequate for iterative design cycles.

The introduction of electronic health records will entail substantial organisational changes to the clinical and administrative staff in hospitals. Hospital owners in Denmark have predicted that these changes will render up to half of medical secretaries redundant. The present study however shows that medical secretaries have a great variety of duties, and often act as the organisational "glue" or connecting thread between other professional groups at the hospital. The aim of this study is to obtain a detailed understanding of the pluralism of work tasks the medical secretaries perform. It is concluded that clinicians as well as nurses depend on medical secretaries, and therefore to reduce the number of secretaries because electronic health record systems are implemented needs very careful thinking, planning and discussion with the other professions involved.

Sustainable IT operation and maintenance through user participation in design and implementation of IT-systems in health care, is only secured if informal and formal knowledge are equally recognized. The paper argues that informal situated knowledge is of significance for the individual health care worker's performance. The concept indigenous knowledge is analyzed as a subset of informal knowledge and reference is made to the concepts of social capital and cultural capital. Finally, an approach rooted in Participatory Learning and Action methods is recommended as a technique for involving staff in IT-system design for technological change.