OnCo
ideasIdea

Every AI output logged in the record with input hash, version and clinician response

Whenever an AI tool gives a result about a patient, the hospital system would permanently record what it saw, which version it was, what it said and what the doctor did with it.

Most AI outputs are transient and not stored, making retrospective audit, harm investigation and performance measurement impossible. The proposal is a standard for AI audit trails in the EHR (FHIR resources capturing model identifier and version, input references and hashes, output, confidence, timestamp, and the clinician's acceptance or override), required for all deployed cancer AI and feeding post-market performance reporting.

Hypothesis
Universal audit trails will make post-market performance measurable at near-zero marginal cost and will allow root-cause analysis of AI-related harms that are currently unexplainable.
Rationale
Aviation's flight recorders and pharmacy's dispensing logs made safety investigation and improvement possible; AI in care has no equivalent record.
What would test it
Implement the audit trail standard at five sites; demonstrate quarterly performance reports derived from it; test its use in retrospective review of ten discordant cases.
Maturity
early clinical
Who has to act
engineering
Cost to try
Small (under $1M)
Years to first evidence
1
Bottlenecks it attacks
  • AI that is built but not validated or deployed · Thousands of cancer AI models are published; a handful are in clinical use, and fewer have shown they help patients.
  • Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.

Connected

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