Abstract: System for decentralized storage and rapid retrieval of medical data among geographically separate locations, connected by data paths of limited bandwidth, which optimizes transmission therebetween. Medical data is separated into bulk content and metadata. Metadata is transmitted to all locations. Bulk content is copied to selected locations based on desired duplication, available storage, distance, transmission cost, data path bandwidth or utilization, likelihood of retrieval calculated from the metadata, requests to use or prior usage of content or information from a system that manages the content. Transmission rate is limited and bulk content is queued for transmission based on priority calculated from metadata, from requests to use content or information from a system that manages the content. Optimal locations for bulk content are recalculated based on requests to use content, new patient appointments, data path or equipment failures. Copies are made or deleted.