Date of Award

July 2016

Degree Type


Degree Name

Doctor of Philosophy (PhD)


School of Information Studies


Jennifer Stromer-Galley


Distributed Cognition, Personal Health Information Management, Personal Health Records, Practice Theory, Sociotechnical Assemblage

Subject Categories

Social and Behavioral Sciences


Personal health records (PHR) are shifting the capabilities and responsibilities of both patients and providers. Influenced by health IT, concepts like patient-centered care, meaningful use, and patient empowerment are commonplace in the healthcare system. As the popularity of personal health records increases, medical providers, healthcare organizations, and health information system stakeholders require a thorough understanding of how patients use these patient facing information portals in conjunction with other artifacts, objects, and practices to manage and maintain their health.

Exploring health information management as a distributed sociotechnical assemblage is the conceptual approach of this research. A distributed cognition perspective lends insight to drawing boundaries and establishing connections of personal health information management practices in conjunction with PHR use. The Department of Veterans Affairs provides a unique setting to further understand PHR use and personal health information management practice through the observation of U.S. military veterans enrolled in the My HealtheVet PHR. This context and conceptual framework lead to the research questions for the proposed study:

RQ1a: What are the personal health information management practices of veterans who use a personal health record?

RQ1b: What health information management practices become distributed beyond the veteran patient?

RQ2a: What health information management assemblages emerge from the distributed work of Veterans that use a personal health record?

RQ2b: What are key functions of the health information management assemblages of veterans?

Through the use of semi-structured in depth interviews, observations, and surveys, data were collected on 22 patients along with their primary care providers and caretakers. Results from a two cycle qualitative coding analysis and analytical cognitive mapping technique reveal bundles of practices for creating reminders, organizing information, and creating information for asking questions and working with primary care providers. Distributed practices emerged that detail the managing of medication, information that is socially distributed, and patient-provider communication through secure messaging. Three health information management assemblage components emerged from the analysis: health events and experiential information, information techniques, and technology and material practices. Each of these components is understood by the ways they become stabilized or destabilized. This research contributes to implications for the design of patient-focused personal health records and informs clinical practice of patient-centered care. The research also makes conceptual and empirical contributions to the practice of health information management and a patient-centered care model of healthcare delivery.


Open Access