Whose Chart is it Anyway?: Autonomy, Bureaucracy, and the Infrastructure of Medical Recordkeeping

Electronic Medical Records (EMRs) serve as an infrastructural network that support and record some of the most intimate details of individuals’ lives, while the companies that maintain this infrastructure remain relatively hidden from public scrutiny. These infrastructures are designed to support institutions and medical providers and rely on patients’ sensitive data, while ignoring patients’ perspectives themselves. In the last two decades, fed by government incentives to digitize recordkeeping, this infrastructure has ballooned in size and allowed the EMR market to be dominated by a few major players without significant oversight.
This thesis argues that the medical records application MyChart, which holds over 35% of the global medical records market share, should be considered a platform, as defined by Gillespie (2010), even though the actors involved may not exactly mirror those of large social media platforms. I argue that in viewing MyChart as a platform we can then consider it “gray media” (Fuller & Goffey 2012), meaning that it is media that is mundane and that mundanity serves a purpose towards furthering the aims of the platform. As Fuller and Goffey state, “Grayness is a quality that is easily overlooked, and that is what gives it its great attraction, an unremarkableness that can be of inestimable value in background operations”, which in the case of MyChart has allowed it to amass a substantive amount of sensitive user data while going relatively understudied. Through using the methods of platform and infrastructure analysis (Gillespie 2010, van Dijck 2018) this paper will excavate these EMR and data infrastructures that have been intentionally grayed and explore the reasons why this has happened.