Shared infrastructure. Local authority.

Local sovereignty does not mean a separate network.

Health systems need dependable ways to coordinate referrals, exchange information and follow through across institutions. They should not have to adopt one application, one operator or another jurisdiction’s policies to do that.

SHN provides a common trust and interaction framework that can be used with local systems and qualified operating paths. Institutions retain authority over their data and decisions, and each supported use follows the permissions and requirements that apply to it.

Consider a referral from a primary-care clinic to a hospital. The clinic needs to send the right information, the hospital needs to respond, and the person needs to know what happens next. Those are local responsibilities that benefit from a reusable common foundation.

The jurisdiction keeps its digital health core. Its systems, data infrastructure, applications, intelligence and decisions remain under local authority. The core does not have to be one system or one central platform; its defining characteristic is local control.

Local operators and technical paths can be used. The Hub is the common path. Where an interaction, existing infrastructure or the jurisdiction requires it, other qualified paths preserve flexibility without changing the common trust framework. Joining the framework does not require sending patient information through a U.S. Hub.

Decisions stay separate where it matters. Network participation, governance participation, operator selection and purchase of an SHN-operated service are distinct choices; none is automatically a condition of another.

Establish locally. Make evidence portable. Recognize where permitted. A credential, relationship or trust assertion established in one jurisdiction is recognized elsewhere only to the extent the receiving jurisdiction and applicable law permit reliance on it. Trust evidence does not itself supply cross-border data permissions. The evidence may travel. Authority does not.

Delaware is an implementation example of the framework at work, not a jurisdictional template imposed on anyone else. Explore the Delaware implementation →