The rapid advancements in artificial intelligence (AI) have revolutionized smart healthcare, driving innovations in wearable technologies, continuous monitoring devices, and intelligent diagnostic systems. However, security, explainability, robustness, and performance optimization challenges remain critical barriers to widespread adoption in clinical environments. This research presents an innovative algorithmic method using the Adaptive Feature Evaluator (AFE) algorithm to improve feature selection in healthcare datasets and overcome problems. AFE integrating Genetic Algorithms (GA), Explainable Artificial Intelligence (XAI), and Permutation Combination Techniques (PCT), the algorithm optimizes Clinical Decision Support Systems (CDSS), thereby enhancing predictive accuracy and interpretability. The proposed method is validated across three diverse healthcare datasets using six distinct machine learning algorithms, demonstrating its robustness and superiority over conventional feature selection techniques. The results underscore the transformative potential of AFE in smart healthcare, enabling personalized and transparent patient care. Notably, the AFE algorithm, when combined with a Multi-layer Perceptron (MLP), achieved an accuracy of up to 98.5%, highlighting its capability to improve clinical decision-making processes in real-world healthcare applications.