Smart Health Network
Utility infrastructure for federated health.
Mission-locked. Capture-resistant. Patient-fiduciary by architectural construction. Delaware Public Benefit Corporation. Federated query-to-data architecture. First-cohort demonstration June 9, 2026 at the Delaware Prior Auth Lab. Production-grade tenancy Q3 2026.
Thesis
Smart Health Network is healthcare federated-data utility infrastructure — designed for persistence, utility-tier operational continuity, generation-long horizons.
Three commitments are load-bearing:
Mission-locked. Legal obligation runs to mission rather than shareholders. Delaware Public Benefit Corporation.
Capture-resistant. Four institutional bodies separated by structural design — operator, governance, patient-fiduciary, philanthropy — with non-aligned reasons-to-exist.
Patient-fiduciary by architectural construction. Substrate commitments to patients exist in the architecture itself, not in policy claims. They are non-modifiable at the architectural-commitment layer.
Substrate-grade infrastructure tier comparable: Stripe (payments infrastructure), Vercel (deployment infrastructure), Anthropic (AI infrastructure), DNS / certificate authorities.
Architecture
The substrate routes operations against payer and provider data — payload-blind. Records never leave their custody. Every operation evaluated against per-operation authority binding.
Identity architecture. Three layers with distinct scopes — substrate routing, identity resolution, patient-claimed identity. Composes with existing identity infrastructure such as commercial EHR patient portals, state HIE master patient indices, and sovereign jurisdiction identity systems. Does not aggregate.
Onboarding patterns. Five patterns at the utility infrastructure layer — EHR integration, health system, payer network, state network, AI agent federation. Sandbox-first; production by invitation.
Developer surfaces. Reference documentation at developers.smarthealthnetwork.org. Operational substrate surfaces at *.smarthealthhub.net subdomains.
Use cases
Five federated use cases architecturally supported at first-cohort scope. Federated prior authorization demonstrates end-to-end at June 9 sandbox-grade. The remaining four use cases reach end-to-end at production-grade trajectory Q3 2026.
Federated prior authorization. Clinical accuracy validation. CARIN Alliance + Da Vinci PAS composition.
Federated patient access. §164.524 right-of-access. CARIN Alliance + CMS Patient Access API composition.
Federated quality measurement. HEDIS. NCQA composition.
Federated public health reporting. §164.512(b) public health.
Federated eligibility verification. 270/271.
All five operate via the same pattern: the substrate routes queries to where data lives. Provider and payer data layers evaluate in place. Records never leave provider or payer custody.
Governance
Four institutional bodies, structurally separated by design:
Smart Health Council — standards and certification. Governs network rules and conformance criteria. Ratifies architectural commitments. Promulgates the Patient Bill of Rights. Council is a Delaware purpose trust, structurally analogous to the Anthropic Long-Term Benefit Trust with healthcare-substrate-governance scope. smarthealthcouncil.org
Smart Health Network PBC — operates the substrate.
Smart Health Trust — patient-fiduciary representation at the governance layer. Advocates for patients, including against the operating company where operational interests diverge from patient interests. (In formation; Delaware purpose trust constitution forthcoming Q3–Q4 2026.) smarthealthtrust.org
Smart Health Foundation — forming 501(c)(3) public charity (Form 1023 filing forthcoming). Receives, redistributes, funds the precompetitive layer. smarthealthfoundation.org
These bodies operate at distinct scopes. Council governance is separate from PBC operation. Trust patient-fiduciary representation is separate from PBC operation. Foundation philanthropic capital is separate from PBC operation.
The substrate commitments to patients exist by architectural construction — they cannot be re-negotiated by any future operator decision, capital event, or political cycle.
Developers
Reference documentation and SDKs at developers.smarthealthnetwork.org.
- Public ADR registry — architectural decision records
- SDKs and integration guides
- FHIR Accelerator IG composition documentation
- Reference architecture for AI agent federation
- Sandbox environment access
Operational substrate surfaces at *.smarthealthhub.net subdomains (sandbox, api, widgets, demo, match).