Design and introduction of an electronic patient record: How to involve users?

Objectives: Two forms of participatory design (PD) - management dominated and end-users focused - are described in the design and introduction of an electronic patients record (EPR) for a mental health care centre. Methods: Qualitative research methods were used to achieve a 'fine-grained' insights into the EPR development process and its impacts. These methods included interviews, document study and observation of project group meetings. Results: Management-dominated PD is highly structured, led by managers and centred around nationalisation of work. End-user focused PD is more bottom-up oriented. Central in this approach are users' working patterns and user needs. In the case described, both forms actually lead to a poorly functioning EPR. It is explained why these results could be expected. Conclusion: Our findings suggest not to reject PD, but to find a more appropriate balance between the two forms of PD.