Information sharing in healthcare remains an unsolved problem despite a plethora of standards and architectures. Effective information sharing is difficult because of the heterogeneity of health information users and data sources, organisational, ethical and legislative constraints and the very demanding requirements of clinical practice. This paper argues that the key requirement of a viable sharing architecture is to support trust in the system and between stakeholders. It uses the concept of a “democratic” approach where citizens can control and verify the use and sharing of data about them and identify ways that some of the value extracted from the data could be assigned to the patient themselves. The reasons for the survival of obsolescent methods are used to inform the design of a proposed citizen-centric architecture using blockchain technology.