Personal Health Records (PHRs), patient-controlled information systems, are believed to be a key to transform healthcare. We argue that a single system, no matter how it is designed, is highly unlikely to have the power to reconfigure a whole sectors. PHRs are not merely technical objects that exist on their own but they should be considered as socio-technical arrangements of systems and users situated and adapted to the specific context of use. We argue that the design process should follow an analysis of this context with particular regard to healthcare system and local health institutions, e-health infrastructures and the strategies used by laypeople to manage their health. Our reflections are the result of our experience in a research/innovation project aimed at prototyping and testing a PHR for the whole population of an Italian region.
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