Design of a Patient-Centered, Multi-Institutional Healthcare Information Network Using Peer-to-peer Communication in a Highly Distributed Architecture

OBJECTIVE to design a community healthcare information network for all 450,000 citizen in the State of Geneva, Switzerland, connecting public and private healthcare professionals. Requirements include the decentralized storage of information at the source of its production, the creation of a virtual patient record at the time of the consultation, the control by the patient of the access rights to the information, and the interoperability with other similar networks at the national and european level. METHODS a participative approach and real-world pilot projects are used to design, test and validate key components of the network, including its technical architecture and the strategy for the management of access rights by the patients. RESULTS a distributed architecture using peer-to-peer communication of information mediators can implement the various requirements while limiting to an absolute minimum the amount of centralized information. Access control can be managed by the patient with the help of a medical information mediator, the physician of trust.