Usage expanded faster than expected
The system is now used in three additional clinics and in more complex follow-up encounters.
The Decide step, with you in it
Review Lab
An AI assistant has been in use for six months. New evidence has emerged. Decide whether to continue, narrow, suspend, or expand its use.
Review loop · step 05, Decide Does the evidence still justify using it exactly as before?
Healthcare · Ambulatory follow-up
Clinical Summary Assistant
A composite case, not a specific deployment. The figures are constructed to make the decision realistic.
An AI system that produces concise summaries of recent patient visits for clinicians before follow-up appointments.
6 months ago Used by 120 clinicians across 3 ambulatory clinics
Generated summary Follow-up visit
Symptoms improved. Medication list reviewed. Allergy history requires source-note confirmation.
Source verification required
What the organization initially permitted
Authorization is bounded permission to rely on a system under stated conditions — not a permanent declaration that it is safe.
Authorization record Active · bounded use
- The system is assistive and does not replace clinical judgment.
- Use is limited to adult ambulatory follow-up visits.
- Clinicians review the underlying note before acting on the summary.
- Performance is reviewed monthly, and a serious incident triggers a fresh review.
What changed after authorization?
Changes in evidence, use, workflow, or policy can invalidate assumptions even when the model itself has not changed.
A recurring omission pattern appeared
A focused review found that approximately 2% of sampled summaries omitted a clinically relevant negation.
Review behavior changed
Median time spent checking source notes fell by 62% compared with the initial rollout period.
Documentation policy changed
A new hospital policy requires explicit documentation of AI use and known limitations.
The evidence so far
No single item decides it. Judge what all of it together means for whether to keep using the system.
Quantitative
Focused error analysis
2.1% of reviewed summaries omitted at least one key negation; errors clustered in medication and symptom histories.
Qualitative
Clinician interviews
Several clinicians described the summary as complete enough to replace a first read of the source note.
Incident
Incident report 47
A missed allergy mention delayed a follow-up prescription until the source note was reviewed.
Quantitative
Review-time telemetry
Median source-note review time decreased from 74 seconds to 28 seconds after the first month.
Make the call
New information has emerged since it was approved. Should the organization keep relying on it on the same terms?
Choose an action to see its consequences and the assumptions behind it.
Kept in this browser alongside your choice, and shown with the consequences below. Nothing is sent anywhere.
Consequences
Choose an action above to see what the organization would need to do next.
Impact of choosing “Continue”
Nothing changes. Clinicians keep the time they save, and the omission pattern and the shorter source-note checks go unaddressed.
Near-term effects
- No interruption to clinical workflow
- No new training or documentation burden
- Known omission pattern remains exposed
Longer-term effects
- 28-second source-note checks become the norm
- Could make future incidents harder to attribute
- Shows staff that the approval’s conditions are not enforced
What this decision depends on
- The sampled omission rate does not represent broader performance
- Clinicians will go back to checking the source note on their own
- The incident was isolated rather than a leading signal
What the organization must monitor
- Negation omission rate
- Source-note review time
- Medication-related incidents
Impact of choosing “Narrow”
The system stays in use where it has held up, and the source-note check becomes mandatory again. That produces the evidence any later expansion would need.
Near-term effects
- Reduces exposure to the observed failure pattern
- Clinicians must check the source note again
- Adds targeted documentation and training
Longer-term effects
- Builds evidence about whether controls work
- A later expansion has to be argued from new evidence
- Keeps a working route for pulling the system back
What this decision depends on
- Clinicians will follow the revised review requirement
- The highest-risk encounter types can be reliably excluded
- A targeted fix can cut the omission rate substantially
What the organization must monitor
- Negation omission rate
- Review compliance
- Clinician-reported workarounds
Impact of choosing “Suspend”
Clinicians lose the tool while the omissions are investigated. It is the right call if the missed allergy looks like the first of several rather than a one-off.
Near-term effects
- Stops exposure while investigation proceeds
- Creates immediate workflow disruption
- Shows staff that one serious incident is enough to stop a tool
Longer-term effects
- May produce the clearest evidence before reauthorization
- Could reduce clinician confidence in future deployments
- May be disproportionate if the error pattern is readily controlled
What this decision depends on
- The potential harm of continued use exceeds the cost of interruption
- A timely investigation can resolve the central uncertainty
- Manual workflow can absorb the temporary loss of the system
What the organization must monitor
- Investigation findings
- Manual workflow burden
- Readiness for reauthorization
Impact of choosing “Expand”
Reads fast adoption as proof of value. Usage grew in the same months that source checks shortened and the omissions appeared, and this choice ignores both.
Near-term effects
- Extends time savings to more clinicians
- More patients are exposed before any control is tested
- Shows the original scope limit can be ignored
Longer-term effects
- More clinics come to depend on the tool before its errors are understood
- Raises the cost of later correction
- Puts an unexplained omission rate in front of more clinicians and patients
What this decision depends on
- Adoption is a reliable proxy for safe utility
- Observed errors will not scale with usage
- Wider use will not cut source-note checking further
What the organization must monitor
- Adoption volume
- Incident rate
- Time to detect cross-clinic failures
How your call sits against the other three
The same six fields for every choice. Your pick is the highlighted column; change it above and the highlight follows.
| Field | Continue Your pick | Narrow Your pick | Suspend Your pick | Expand Your pick |
|---|---|---|---|---|
| What the choice does | Nothing changes. Clinicians keep the time they save, and the omission pattern and the shorter source-note checks go unaddressed. | The system stays in use where it has held up, and the source-note check becomes mandatory again. That produces the evidence any later expansion would need. | Clinicians lose the tool while the omissions are investigated. It is the right call if the missed allergy looks like the first of several rather than a one-off. | Reads fast adoption as proof of value. Usage grew in the same months that source checks shortened and the omissions appeared, and this choice ignores both. |
| How well the record supports it | Weakly supported response | Proportionate response | High-control response | Weakly supported response |
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Scroll sideways for more
There is no risk-free answer
A defensible decision identifies the conditions under which using it is still justified, the uncertainty being accepted, and the facts that would force another review.
A sound decision to keep relying on it is:
- bounded to a defined use and population;
- traceable to evidence and explicit assumptions;
- open to challenge by affected people;
- correctable when the operating facts change.
Revised