Many healthcare units are creating cloud strategies and mi- gration plans in order to exploit the benefits of cloud based computing. This generally involves collaboration between healthcare specialists and data management researchers to create a new wave of healthcare tech- nology and services. However, in many cases the technology pioneers are ahead of government policies as cloud based storage of healthcare data is not yet permissible in many jurisdictions. One approach is to store anonymised data on the cloud and maintain all identifying data locally. At login time, a simple protocol can be developed to allow clinicians to combine both sets of data for selected patients for the current session. However, the management of o↵-cloud identifying data requires a frame- work to ensure sharing and availability of data within clinics and the ability to share data between users in remote clinics. In this paper, we introduce the PACE healthcare architecture which uses a combination of Cloud and Peer-to-Peer technologies to model healthcare units or clin- ics where o↵-cloud data is accessible to all, and where exchange of data between remote healthcare units is also facilitated.