Drift and shift in the organizing vision career for personal health records: An investigation of innovation discourse dynamics

Organizational information technology innovations develop and diffuse through the efforts of communities of stakeholders working in cooperation and competition to articulate, motivate, and diffuse an innovation. Community members' discourse can reveal competing interests and tensions that influence whether ideas central to the innovation coalesce, drift apart, or dissipate and thus the innovation's trajectory. To investigate these dynamics, we adopted the theoretical lens of the organizing vision framework and historical and discourse analysis methods to study developments with personal health records (PHRs) in the U.S. for over a decade (2003-2013). Our analysis revealed ongoing drift in PHR discourse across the innovation community despite concerted efforts by key stakeholders to promote an overarching vision. Shifts in discourse developed as four competing PHR versions coalesced around different institutional arrangements for health and health data stewardship, health data stores, and innovation community actors. This analysis furthers our understanding of career dynamics of an organizing vision and the implications of these dynamics for innovation diffusion. The study also highlights implications for health IT innovation research and for practice.