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.