Governed for perpetual independence and neutrality.
The reason healthcare’s data ended up captured is that no one designed the structure to prevent it. This network is built with that lesson absorbed at the foundation: separate the powers, put the obligation to patients, and make neutrality a property of the architecture, not a promise.
The Mindshare Institute and Smart Health Network Announce Health Care Utility Governance Collaboration as Delaware Puts the Network to Work
The Mindshare Institute℠ and Smart Health Network have announced a governance collaboration establishing Smart Health as a Health Care Utility℠ — neutral, shared infrastructure governed in the interest of those who depend on it, rather than operated as a proprietary commercial platform.
The model deliberately separates powers. Smart Health Network PBC operates the network but does not govern it: network rules — including any change to fees — are set and enforced by a governance council drawn from the stakeholders who depend on the network, and a separate data trust serves as fiduciary for patients, protecting individual rights and consent. The separation is the point — no single stakeholder, including Smart Health itself, controls the utility all parties depend on, and patients hold a structural voice, not a symbolic one.
“Smart Health shows what becomes possible when infrastructure is built to serve every stakeholder — and governed so it stays that way.”
Four independent constitutional institutions, separated by design.
A participant’s choice of operating model does not change its standing on the network — a gateway you host, a gateway SHN hosts, and other approved operating models participate under the same published rules, rights, obligations, and utility fees.
A state’s launch program is state-governed: a Program Executive Committee chaired by a senior state official, payments released only on verified deliverables, quarterly reporting, audit and clawback rights, and exit rights if funding ends or the state discontinues. The network itself is governed separately — rules, participation terms, and releases are set through the independent Council under published terms that apply the same way in every state. No state, including the first ones, holds special authority over the network other states join.
Three questions worth asking of any shared infrastructure.
Who does the obligation run to?
Patients. The Smart Health Data Trust holds fiduciary duty directly to individuals — not to the operator, not to payers, not to providers.
Can it be captured?
No. Constitutional separation of powers, with reserved powers separated by design. No ordinary acquisition path can override the mission lock, patient rights, or neutrality covenants.
Does the price tend toward the lowest sustainable cost?
Yes. SHN PBC operates the rails as a utility at minimum sustainable cost. The same published utility fees apply to every comparable participant. Surplus is reinvested, not extracted. Investor returns are capped, so no one profits from raising the fee.
These are not promises. They are architecture. Promises can be renegotiated. Architecture is what is left when promises run out.
Governance inquiries
Questions about the Council, Trust, or Foundation: governance@smarthealthnetwork.org.