Architectural Constraints on the Bootstrapping of a Personal Health Record

During the last decade we have seen a proliferation of electronic personal health record systems (PHRs) aiming to change the way people manage and receive healthcare. However, many of these initiatives have failed to take-off. We inquire into such unsatisfactory outcomes by drawing upon the perspective proposed in the information infrastructure (II) literature. This literature views the value of PHRs as dependent on the number of actors using them. This poses a challenge for designers (referred to as ‘bootstrapping’): how to persuade users to adopt a PHR when the user base is still small. To address the bootstrapping challenge, II literature suggests starting with a simple solution that creates immediate user value and enables users to enrol gradually. This paper seeks to explore how PHR architecture can hinder PHR bootstrapping through a longitudinal case study on the implementation of an integrated PHR. Our case analysis identifies four architectural constraints: poor data quality; coordination across heterogeneity; privacy and control; and re-configurability. This paper concludes by discussing the implications of the findings for the literature on personal and electronic health records and on the design of information infrastructures.