Project HealthDesign is a country-wide initiative in the United States designed to stimulate innovation in personal health records (PHRs). Nine grantee teams engaged in an 18-month long design and prototyping process. Two teams addressed the needs of children and adolescents; three created novel approaches to help adults prevent or manage metabolic syndrome; three groups employed interface innovations to assist patients with chronic care management and one team devised a novel calendaring system to assist patients undergoing complex medical/surgical treatments to integrate care processes into their daily lives. These projects not only included development and testing of novel personal health records applications, but also served as the starting point to specify and implement a common technical core platform. The project advanced PHR development in two key ways: intensive user-centered design and a development architecture that separates applications of PHRs from the infrastructure that supports them. The initiative also allowed systematic investigation of significant ethical, legal and social issues, including how privacy considerations are changed when information technology innovations are used in the home and the rebalancing of the authority structure of health care decision making when patient-centered approaches guide the design of PHRs.