Balancing rights and utility in determining power relationship ratios in e-health systems

Governments and private health organizations are adopting e-health systems as a means to improve medical service delivery and reduce costs. While some e-health systems show indications of success there have been some expensive failures, most notably in the UK. Power-relationship ratios determined by a chosen balance of rights versus utility could explain e-health system success or failure. Rights over the portability of medical information have become a contentious e-health issue which could limit desired effectiveness and efficiency. There are conflicts over information governance issues such as consent, privacy, choice, fairness, balancing the rights of the individual versus the common good, questions about who owns health information and what can be done with it. This paper uses a historical institutional framework to compare the path dependencies inherent in adopting opt-in, opt-out or mandatory e-health systems which may result in different outcomes. Each approach makes assumptions about a balance of rights versus utility that may directly impact medical service delivery and costs. These decisions institutionalize e-health power-relationship ratios between e-health actors. The concepts of capacity, competence and ableness are used in an effort to determine powerrelationship ratios and what rights e-health stakeholders should have. Striking an optimal balance between rights and utility may well be one of the key choices governments make in order to successfully institutionalize e-health systems, transform service delivery, increase the efficiency and effectiveness of public sector service provider and citizen interaction, and, through the lens of citizen satisfaction, enhance the legitimacy of e-government systems in general.