In order for MyPHRMachines to become a viable solution to achieve health care cost reduction and quality of care
improvement constantly advocated in modern societies [21], researchers will have to pay attention to several issues arising from the contextualization of MyPHRMachines in the complex health care ecosystem.
A useful frame of reference in this context is the one of institutional theory, which has often been used to address the shortcomings of technological and business innovation in health care [22], [23]. It predicates that organizations are
often influenced by normative pressure, arising internally, e.g. relative power of physicians and administrative managers, or at the industry level, e.g. imposed reimbursement schemes, leading them to choose legitimated elements that have often the effect of directing attention away from task performance and social welfare. According to institutional theory, the
relationship among processes, people, business models and our proposed solution, in particular, needs further investigation.
Regarding processes, we need to investigate how MyPHRMachines will impact administrative and clinical processes currently in place in health care institutions. For instance, administrative processes are usually driven by data available in local EMRs, which may be inconsistent with the data possessed by the patient. Another factor influencing the success of our solution can be the management of the coexistence of patients adopting and non-adopting personallyowned health care records, since we cannot assume complete penetration of such a technology without government sponsoring, at least in the initial transitory period.