Making connections through online asthma monitoring.

OBJECTIVES: This was an observational study of an online asthma monitoring system in Danish primary care practices aimed at exploring the reasons why information and communication technologies (ICTs) intended to connect chronic patients with their care provider fail to become a durable part of treatment practices.
METHODS: An ethnographic case study was performed, including semi-structured interviews conducted with eight Danish general practitioners (GPs) and one nurse, and participant observation of the system in use.
RESULTS: The technology never became a durable part of any of the studied practices. Rather, it was used in different ways (as a patient tool, a nurse intervention tool, or a tool associated with doing clinical research), providing different actors with different kinds of agency. DISCUSSION: Rather than challenging the clinical autonomy of the GPs or granting the patient with autonomy, the technology affords -- through these different enactments -- various constellations of agency for the GPs and other actors involved in asthma treatment. Problems met in relation to implementation of ICT for chronic disease management are better understood as instances of negotiating which connections are valuable in clinical work. Specific, ethnographic accounts of the local co-construction of agency and technology can provide more relevant insights into the changes entailed by the introduction of ICT for chronic disease management.