Substrate as the institutional-architecture layer beneath the FHIR Accelerator universe.

Substrate is the layer beneath TEFCA, not beside it

TEFCA federates provider records → payer (data movement). Smart Health Network federates the criteria query → provider's data (query movement). Substrate provides the institutional-architecture-and-fiduciary layer beneath the FHIR Accelerator universe behavioral interoperability layer.

Five federated use cases at sandbox-grade June 9 — UC22 Federated Prior Auth (canonical lead) · §164.524 Federated Patient Access · HEDIS Federated Quality Measurement · §164.512(b) Federated Public Health Reporting · 270/271 Federated Eligibility Verification.

FHIR Accelerator universe composition

• Da Vinci

  Payer-provider clinical interoperability

  IGs: PAS · CRD · DTR · CDex · DEQM · PDex · PCDE · PCT · HRex · Member Attribution · Risk Adjustment · PDex Notifications · ePrescribing

  Composition: Da Vinci PAS composes with Federated Prior Auth canonical pattern (UC22). Da Vinci PDex composes with Federated Patient Access (§164.524). Da Vinci DEQM composes with Federated Quality Measurement (HEDIS via NCQA). Da Vinci CDex composes with Federated Public Health Reporting (§164.512(b)) and Federated Eligibility Verification (270/271).

• FAST

  FHIR at Scale Taskforce — security, identity, federation

  IGs: Security/Identity · Hybrid+Intermediary · National Directory · Consent

  Composition: FAST Security/Identity composes with Federated Identity Bridge UX + Smart ID Option (c) Hybrid + substrate-fiduciary-managed handle multi-role primitive (per ADR-033).

• Helios

  Public health reporting

  IGs: Public health surveillance reporting

  Composition: Helios composes with Federated Public Health Reporting (§164.512(b)) — substrate routes reportable-disease query payload-blind; provider data layer evaluates against CDC + state DOH published criteria; aggregate report returns; records never leave provider.

• CARIN Alliance

  Patient access

  IGs: CARIN Blue Button · CARIN Patient Identity · Consumer-Directed Payer Data Exchange

  Composition: CARIN Alliance composes with Federated Patient Access (§164.524) at the patient-side surface (Smart Health Account at smarthealthhub.net + Smart Widget for Patient Access).

• CodeX

  Oncology

  IGs: mCODE (Minimal Common Oncology Data Elements) · CodeX Cancer Pathway Builder

  Composition: CodeX composes with substrate Federated [use case] pattern at oncology data layer; Q4 2026 substrate-state-event-paced.

• Gravity

  Social determinants of health

  IGs: Gravity SDOH Clinical Care

  Composition: Gravity SDOH composes with substrate Federated Patient Access + Federated Quality Measurement at SDOH data layer; Q4 2026 substrate-state-event-paced.

• Vulcan

  Research

  IGs: Vulcan Real-World Data · Vulcan Adverse Event Reporting

  Composition: Vulcan composes with substrate Federated [use case] pattern at research data layer; Q1-Q2 2027 substrate-state-event-paced.