On creating and sustaining alternatives: the case of Danish telehealth

This paper presents and discusses an initiative aimed at creating direct and long lasting influence on the use and development of telemedicine and telehealth by healthcare professionals, patients and citizens. The initiative draws on ideas, insights, and lessons learned from Participatory Design (PD) as well as from innovation theory and software ecosystems. Last, but not least, the ongoing debate on public finances/economy versus tax evasion by major private companies has been an important element in shaping the vision and creating support for the initiative. This vision is about democratic control, about structures for sustaining such control beyond initial design and implementation and about continued development through Participatory Design projects. We see the \"middle element\", the structures for sustaining democratic control beyond initial design and implementation as the most important and novel contribution of the paper.