Improving Shared Decision Making (SDM) and patient-provider communication, and providing all citizens with equal access to health information is a high priority health policy goal. In this interdisciplinary, international research collaboration we developed and tested CONNECT (Care Online: Novel Networks to Enhance Communication and Treatment), a patient portal that integrates a suite of context-sensitive, multi-modal patient communication and information tools into a patient-clinician shared electronic health record that patients can use seamlessly through heterogeneous networks from different locations (home, hospital, doctor’s office). We explored requirements and tested feasible solutions that safeguard data security and confidentiality; adapted user interfaces to different users, devices and contexts of use; and ensured safe and efficient data transfer through heterogeneous networks. We also investigated clinicians’ and patients’ needs for documentation, information, and data sharing to support communication, SDM and continuity of care. Further, we assessed the suitability of medical/nursing vocabularies that are necessary for data sharing among patients, clinicians and systems and developed a set of tools that can “translate” between patient-oriented terms and the nursing/medical terms from standardized medical vocabularies. Finally, we evaluated Connect’s usage, perceived usefulness and ease of use by patients and clinicians. This work contributed significantly to new forms of interactions that can radically improve patient-provider communication, SDM, care quality, and continuity of care, and that has broad applicability for many health and social services.