" Despite progress in creating standardized clinical data models and interapplication protocols, the goal of creating a lifelong health care record remains mired in the pragmatics of interinstitutional competition, concerns about privacy and unnecessary disclosure, and the lack of a nationwide system for authenticating and authorizing access to medical information. The authors describe the architecture of a personally controlled health care record system, PING, that is not institutionally bound, is a free and open source, and meets the policy requirements that the authors have previously identified for health care delivery and population-wide research. ...... CONCLUSION: Some organizations are beginning to grant patients electronic access to a longitudinal view of their hospital-based records. Although this approach is very encouraging, it fails to solve the problem that a patient's medical records are generally fragmented across treatment sites, posing an obstacle to clinical medicine, research, and public health efforts. A system such as PING, however, thrives in the setting of such institutional efforts because data are mobilized from legacy systems and prepared for patient consumption. PING, although still a work in progress, addresses issues of portability, security, and access control primarily for data originating in institutional, office, and laboratory records. Although there are myriad issues raised by patients reading their own records, we believe that, for the foreseeable future in the United States, it is only by leveraging the patients' right to have copies of their own records that we can hope to achieve effective and lifelong continuity of the medical record across all health care institutions. Since the approach of creating personally controlled health records, which we have advocated for a decade,29 is now at the very core of the larger NHII conversation, we hope that this paper serves to help focus that conversation on the specific technical issues required to achieve the vision. "

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