Participation, power, critique: constructing a standard for electronic patient records
Abstract
This paper examines the scope of participatory design on the basis of the case of a national standard for electronic patient records (EPR) in Denmark. The relationship between participatory methods and techniques on the one hand and critical and emancipatory aims on the other is discussed within the framework of participatory design. Some argue that participation in itself entails striving towards democracy; others argue that the tendency to focus upon tools, techniques and the arena of single projects should be supplemented by emancipatory aims such as technology assessment and a critique of dominance. These issues are discussed through the controversies surrounding the test of a prototype application based on BEHR in late 2004, a standard for EPRs (Basic Structure for Electronic Health Records). I argue that participation is valuable, but that the scope of participatory design should also include critical conceptualizations of participation, power, methodology and knowledge. Finally, standards can be crucial cases to examine for participatory design, since they affect the work of many people and call for a focus on arenas beyond the single design project.
