Institutional Practice

Seven Institutional Questions for Consequential Healthcare AI

Trustworthy AI depends on more than a technically capable model or an approved policy. Institutions must connect standards, clinical judgment, cybersecurity, operational authority, evidence, and executive accountability across the full lifecycle of consequential AI. TTIC uses the following questions to make those institutional obligations explicit.

The Questions

What every institution must answer

01What decision is being governed?
Define the consequential decision, affected population, workflow, institutional context, and outcome at stake.
02What is the system authorized to contribute?
Define permitted purpose, scope, boundaries, prohibited actions, and conditions requiring reauthorization.
03Who may recommend, approve, veto, stop, override, and accept residual risk?
Assign decision rights across clinical, technical, security, privacy, legal, quality, operational, and executive functions.
04What evidence must exist before and after the decision?
Define provenance, verification, sufficiency, accountability, exception, outcome, and retention requirements.
05What happens when evidence or system behavior is insufficient?
Specify hold, escalation, fallback, override, incident, and learning pathways before the exception occurs.
06How will the institution know governance is working?
Measure safety, security, decision latency, evidence completeness, exceptions, adoption, outcomes, and value through accountable operational objectives.
07What remains institutionally owned?
Preserve institutional decision rights, clinical judgment, production authorization, evidence custody, and outcome accountability regardless of vendor or model.
Boundary

Standards authority, not product endorsement

TTIC is independent and product-neutral in its consortium, standards, and certification activities. Medigram is a commercial implementation of decision-governance infrastructure led by TTIC's Founder & Chair. TTIC authority does not substitute for product evidence, independent evaluation, customer diligence, or institutional authorization.

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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/resources/institutional-questions-consequential-ai/

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. “Seven Institutional Questions for Consequential Healthcare AI.” Trustworthy Technology & Innovation Consortium (TTIC), 2026. https://trustworthytechnologyinnovation.com/resources/institutional-questions-consequential-ai/.