This research-in-progress paper reports on an in-depth case study that integrates literatures from health care policy, information systems, and strategic management to explore how an entrepreneurial firm shapes its organizational boundaries in the context of the complicated healthcare ecosystem in the United States. In doing so, we investigate the implications of boundary shaping decisions on the development and deployment of an electronic personal health record (ePHR) system. The growing call for the use of ePHR systems is based on the logic that providing personalized, timely healthcare information that supports an incentive-based compliance program will not only lower healthcare costs but lead to healthier individuals and improved organizational performance. However, as mentioned in this paper, populating ePHR systems is a huge data integration challenge that requires the successful coordination of many players with potentially competing objectives. By adopting the perspective of a startup firm within this context, we illuminate the impact of industry fragmentation and competing goals and objectives within the health care context, and show the importance of boundary decisions that promote cooperation and tight integration to facilitate the information flows needed to populate employer sponsored ePHR systems.