Organizations have become adept at initiating and managing change, but tend to enact change reactively. Patients are increasingly behaving as consumers, and are beginning to drive the process of organizational change. However, traditional models of initiating and transitioning change appear less relevant in this context. The personal health record (PHR) perhaps best exemplifies patient empowerment in their medical care. This paper examines the history, advantages, and limitations of personal health records, and delineates patient and provider perceptions. The impact of consumerism on clinical practice, organizational changes driven by patient requests, and the role of patients, providers, the media, and marketing are analyzed in this study. Tethered and untethered PHRs are compared and contrasted from the organizational perspective, and the safety and security implications of PHR use are discussed.