This chapter explores how in developing patient-centred e-health systems it is possible to accommodate heterogeneous characteristics of end-users and their diverse health and care contexts. It concurs with conventional sociotechnical design paradigms that argue systems must be easy to use, fulfill a perceived need, and present a clear value proposition to ensure successful adoption and utilisation by patients. The chapter also highlights the need for awareness of a number of key challenges relating to emerging discourses on ‘empowering patients’ and ‘e-health’. The implications of these challenges for the development of a truly patient-centred e-health approach are explored in a detailed case study. This chapter contributes to research focused on supporting patients to become genuine co-participants in their own care, health and well-being. However, it also acknowledges that part of the challenge of achieving this goal requires a focus on assisting clinicians to learn to respond to this shift in the autonomy of decision- making