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AI Capital Decision Gate

A one-page instrument for determining whether an AI investment has sufficient evidence, accountability, value, and risk controls to fund, scale, renew, remediate, or stop.

Investment under review
Reviewed by
Date
1. Evidence
  • Value thesis: the specific financial or operational outcome expected, and how it is measured, is written down.
  • Attribution method: evidence exists separating this system's contribution from unrelated changes.
  • Production evidence: performance data comes from production use in the review period, not pilot results or vendor claims.
  • Total cost of ownership is documented: technology, integration, infrastructure, security, monitoring, workflow redesign, training, governance, remediation.
2. Accountability
  • One named executive owns the total outcome: not the technology, not the vendor.
  • Every function with a stake (clinical, technical, security, legal, operational) has provided evidence of its own performance.
  • Escalation authority is explicit: who can pause, correct, or stop this system, and how.
3. Value
  • Realized value, not projected value, is measurable against the original thesis.
  • The value is attributable to this investment specifically, not general trend, market, or seasonal effects.
  • The value trajectory justifies this investment's continued claim on capital relative to alternative uses of that capital.
4. Risk Controls
  • Clinical and operational thresholds are predefined and actively monitored, not implicit.
  • Cybersecurity and technical reliability controls are evidenced, not assumed.
  • Legal, compliance, and liability exposure has been assessed for the system's current scale of deployment.
  • Incidents and exceptions in the review period have been logged and addressed.
The gate: which decision does the evidence support?

Read down, not across. Each outcome names the minimum the checked sections above must actually support, not a score to average.

Fund
Initial capital commitment. Evidence (value thesis, attribution method) and Accountability (named owner) must be in place before Value or Risk Controls evidence can exist. Proceed only with explicit checkpoints defined for deployment.
Scale
Expanding an already-funded, deployed system. All four sections must be checked. No item may be assumed carried over from the funding decision: scale is a new capital claim, not a continuation.
Renew
Continuing an existing investment at its current scope. Evidence and Value must be checked; Risk Controls must be re-verified for this review cycle, not carried over from a prior one.
Remediate
The system stays in production, but with corrective action and a defined timeline. Applies when Risk Controls or Accountability has an unchecked item, but Evidence and Value still support continued clinical or operational need.
Stop
Suspend or terminate. Applies when Evidence cannot answer the value thesis or attribution question, when any Risk Controls item is unresolved past its remediation window, or when no named accountable owner exists.
Where to go next

New to why this gate exists? Start with Healthcare AI Has Become a Capital Accountability Problem.

If a section above surfaced real gaps, not just missing paperwork: Someone Must Own the Seams and AI ROI and Patient Safety Are Starving for General Management address what adequate accountability and general-management capability actually require.

If your institution cannot yet answer these questions at all, not just for one investment but structurally: the accredited IEEE/UL 2933 standard is the institutional framework for building this capability. See Standards.

Evaluating the institutional capacity a counterparty consumes, rather than the capital an initiative consumes? See the AI Risk Stewardship Gate: does this counterparty justify the institutional capacity it consumes?

The two gates work together. Capital committed, from this gate, plus capacity consumed and expected downside, from the AI Risk Stewardship Gate, is the full investment and exposure a decision requires.

Read more: Price Alone Does Not Establish AI and Agentic ROI.

Trustworthy Technology & Innovation Consortium · trustworthytechnologyinnovation.com · This instrument is educational material, not investment, financial, legal, or clinical advice. TTIC requirements complement rather than replace independent clinical, technical, operational, legal, and financial judgment.

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Published by
Trustworthy Technology & Innovation Consortium (TTIC)
Author
By Sherri Douville, Founder & Chair, Trustworthy Technology & Innovation Consortium (TTIC)
Originally published
Last updated
Canonical resource
https://trustworthytechnologyinnovation.com/ai-capital-decision-gate

Provenance: This resource is an original practitioner architecture from the Trustworthy Technology & Innovation Consortium (TTIC), developed to operationalize healthcare AI governance standards into institutional practice. External standards and source materials are cited separately.

Cite this resource

Sherri Douville. “AI Capital Decision Gate.” Trustworthy Technology & Innovation Consortium (TTIC), 2026. https://trustworthytechnologyinnovation.com/ai-capital-decision-gate.