JMIR Publications

ABSTRACT

Health data are distributed across organisations, while care, research, and artificial intelligence (AI) increasingly depend on using data across settings and populations. Health systems have often responded by concentrating data in shared environments. This works where common custody is lawful, trusted, and practical, but not where data, models, or services cannot or should not move under common control. Distributed access, analysis, model training, and exchange are already possible, but technical interoperability alone does not establish how independently governed organisations collaborate. Collaboration also requires agreement on purpose, participants and resources, authority and permissions, responsibilities and risks, governance, and incentives, which we call the relational configuration. When collaborations change, parts of it must be established again. The internet provides a precedent for making coordination more reusable. Before common protocols such as TCP/IP, capable but independently controlled networks remained disconnected; the “Islands of Networking” problem. Standardising only what had to cross their boundaries allowed them to interoperate while preserving local autonomy. Health faces an analogous “Islands of Data and AI” problem, with the additional requirement that participation across organisational boundaries must be governed. Federated Computing offers an architectural framework for governing participation across independently controlled organisations under sovereignty constraints. Relevant elements of an agreed relational configuration can be represented as verifiable capabilities and evaluated through admission when an operation crosses a boundary of independent authority producing evidence for accountability. Our Open Health demonstrator provides evidence of feasibility, not of health-system scalability or value. The organising reference for coordination should follow its purpose for whole-person and cross-sector care, the person can be the common reference for identifying relevant resources, while authority remains grounded in legitimate arrangements. We define the federated data advantage as the collective capacity created when complementary distributed resources can be used together under governed conditions without requiring common ownership. Whether this advantage can be realised in practice requires evidence that reusable coordination reduces the collaboration effort, remains governable across institutional boundaries, and creates value for participants and health systems.