The Power of Information Technology: Governing Patients through Technology

Since 1990s the English NHS has used Information and Communication Technology (ICT) such as Electronic Patient Records and more recently health apps in order to improve healthcare delivery and patient experience. The rhetoric of patient choice has driven past policy but various studies have suggested that choice has failed to materialise (Dent, 2006; Henwood et al., 2011; Fotaki, 2010). In 2012 the Department of Health introduced the policy ‘The Power of Information’ whereby choice is envisioned to be enacted yet again through patients’ ‘informatisation’ supported by various electronic interfaces. According to this new policy patients are supposed to be involved in decision-making processes that relate to their health. Indicative is the rhetoric of ‘no decision about me without me’ that underpins this policy. This new policy indicates a shift of the discourse on patients from ‘health consumers’ to ‘empowered patients’. A fundamental aspect of this shift is the new role that is ascribed to patients; one that sees patients not as mere consumers but as producers of health information. ICT and more specifically health applications enable this new role by allowing patients to input and retrieve health-related information and to interact with healthcare professionals and patients electronically, facilitating  management of their health. The aim of this paper is to examine the shift of this discourse and to study how patients are being governed (by themselves and by others) through assumptions embodied into ICT. We draw upon Foucault’s work on ‘governmentality’ (Foucault, 1991), which has been used extensively to studies of healthcare reforms but has been applied much less so to studies of the role of ICT in shaping patienthood. We report on a pilot qualitative study and use interviews with relevant stakeholders such as health policy makers (NHS England); health ICT developers and representatives of patient groups and associations.