The qualitative analysis mentioned previously focused on TF and did not explicitly investigate implicated human values. However, TF can be used as an analytic method in VSD, in that the frames can serve as a basis to further identify the corresponding values. The identification of TF can be seen as an activity within both, empirical and technical investigations as the focus is on (a) particular stakeholders, and (b) their interpretation of a particular technology. For this article, the previously identified TF have been re-examined in order to identify corresponding values. In the following, some examples of human values (cf. Friedman and Kahn Jr, 2007) are presented, that may have influenced or informed the HCP’s interpretation of PAEHR.
Ownership and property
Part of the physician’s TF was the view of the record as their work tool and hence of themselves as its owner. Thus, giving patients online access may be seen as repurposing their work tool. Many patients, however, regard themselves as the owner and demand access to their health information (see e.g., the “liberate health data” campaign by Campos and Sebastian 2015).
Part of the TF, particularly in the domain “technology-in-use”, was the assumption that giving patients access to their EHR would interfere with the work processes. Patients would be able to read the content even before the HCP had seen them, thus they anticipated the need to “catch up” in less time. Furthermore, physicians were concerned that patient would use PAEHR to monitor the physicians. In this framing, PAEHR conflicts with the professional autonomy of HCPs, who for instance do not want to be pressured to change their work practices or being monitored.
One aim of PAEHR was to enhance patient participation and empowerment by giving patients digital access to their medical information (Erlingsdottir and Lindholm 2015, p. 23). The human value of autonomy can thus also be related to the personal autonomy of the patient. This could potentially be identified by technological investigations in VSD. However, an essential part of the physicians’ TF was that patients would not be able to understand the content and would become unnecessarily anxious. Furthermore, as identified in the TF related to the process, physicians preferred to complete the steps in their process (i.e., interpret test results, make a diagnosis, consult colleagues, determine treatment) before giving that information to the patient (Grünloh et al. 2016). This part of the TF can be related to professional authority, which is in conflict with PAEHR by which patients access their information directly. Katz (2002, p. 85ff) discusses professional authority in that it has been a millennia-long tradition that physicians are the solitary decision maker and thus are reluctant to depart from familiar practices. However, patient-centred care has been defined as being respectful of and responsive to individual patient preferences, which ensures that patient values guide all clinical decisions (Barry and Edgman-Levitan 2012, p. 780). Thus, professional authority implied in the TF conflicts with the personal autonomy of patients.
Privacy and trust
Providing patients with a log list tackles the issue that HCPs can potentially access them without permission. The idea is that patients easily recognise the names of acquaintances who have no business reading their records. This feature is supposed to support patients’ privacy. However, physicians perceived it as a surveillance tool and assumed that patients mistrust them if they read the log list (Grünloh et al. 2016). During the interviews, the physicians referred to their professional expertise and that thus patients should trust them (Grünloh et al. 2016). In this case, interpersonal trust between HCP and patient is perceived to be endangered through a feature for the patient, that is supposed to establish patient’s trust in the technology. The endangered “trust in the relationship” was identified through TF, while “trust in the technology” through a particular feature could be identified through technological investigations in VSD.
Human welfare and well-being
The physicians were concerned that patients could be harmed by reading their EHR (Grünloh et al. 2016). HCPs were also concerned that this system would have a negative effect on the quality of healthcare (Huvila et al. 2013). A study with cancer patients found that direct access to test results can also be crucial for patients’ well-being (Rexhepi et al. 2016). The patients described that anxiety was rather caused by having to wait for a long time to receive the results from their physician. They perceived the delay as having a negative impact and thus saw an improvement on their well-being by PAEHR (Rexhepi et al. 2016). We can see here that both stakeholders share the same value: the wellbeing of the patient. Thus, the tensions are not among values but among TF, which can then be addressed accordingly. For example, one could investigate whether the physicians’ frames are based on mere assumptions and whether positive patient experiences can be found also on a large scale.
These examples illustrate tensions between values and thus one has to balance and make trade-offs between them. Tensions may appear in the same value dimension (e.g., autonomy of group A is in conflict with autonomy of group B); or in another value dimension (e.g., personal autonomy of group A conflicts with privacy of group B). In addition, tensions can occur between TF of stakeholders, even if their values concord.