# The Holistic Perspective of the INCISIVE Project--Artificial Intelligence in Screening Mammography
## 4 Results to the Existing Data Repository
### Federated Sharing  
The improved usage of health data can help to validate the relevance of novel diagnostic and therapeutic methods as well as directly improve care. Patient care may benefit from the availability of actionable data-driven standardized decision support across care-delivering organizations. In that context, INCISIVE aims to become a facilitator for interoperability and interconnection between its stakeholders, and for data as well as services shared for the optimized management of cancer disease. To this end, the INCISIVE pan European federated repository of health images builds on a federated storage approach and employs digital processes and information technology to facilitate interconnection between willing participants, whether data providers and/or data consumers. By leveraging existing data interoperability standards (HL7 FHIR, DICOM, SNOMED, and LOINC), open technology (The Esthesis platform [36]), and concept (federated storage), it enables open, consistent, quality-assured, and easy-to-use innovative data exchange and services for healthcare providers, medical researchers, and AI developers in a federated manner. The INCISIVE platform is divided into three parts (see Figure 7). * **The data preparation toolset** is a set of tools that operate at each data provider's site before the data federation stage so that the data becomes GDPR-compliant and appropriately processed (e.g., annotated, where relevant). The main tools that support this process are the data de-identification tool, the data annotation tool, the data curation tool, and the data quality check tool. These tools ensure that the data undergoes a correct pre-process to fulfill the system preconditions before being stored in the INCISIVE platform (see Section 3.1 data integration and 3.2 annotation and de identification). * **The federated node** is the node that is hosted by the data provider where the data is stored. The data do not leave the related premises; therefore, the data partners keep full control. * **The federated space** is the Cloud environment that contains the centralized services required to offer the federated INCISIVE functionalities. Parts 2 and 3 constitute the repository itself. Figure 7: INCISIVE preliminary architecture. The architecture is subject to changes and updates in order to integrate all relevant user requirements and specifications. A revision is currently underway towards a hybrid architecture that will also include a central data repository node in order to allow for more possibilities in data reusability and flexibility in data exploitation. This approach will allow very large data collections to be stored locally at sites, address data privacy and sovereignty issues, and make use of real-time Cloud high-performance resources for specific uses and specific datasets. To date, the INCISIVE federated repository is composed of multiple interconnected nodes; hence, while physical entities of the data providers/consumers of the INCISIVE consortium are distributed around Europe, they can be virtually connected through INCISIVE interfaces, allowing the seamless and authorized access to secure data. Each data provider constitutes one node of the decentralized system, and all nodes are equally responsible for contributing to the INCISIVE architecture's overall goal, e.g., health data sharing and management for cancer business intelligence purposes. Data sources are controlled locally by their owners and regulations, and policy restrictions including GDPR are enforced appropriately without the data leaving the local premises, which in many cases is strongly preferred by hospitals and data owners in general. Multiple databases of cancer data/images operate as a single virtual one and provide a unified source of data for front-end applications and services, e.g., AI development for cancer management purposes. The only prerequisite is that all data from the local nodes is converted to the INCISIVE CDM (in Section 3.3).