JMIR Publications

ABSTRACT

Background:

The rapid emergence of artificial intelligence (AI) has outpaced its formal adoption in healthcare organizations, contributing to the emergence of Shadow AI, defined here as the use of unauthorized AI tools by medical professionals. While Shadow AI offers potential efficiency gains and higher performance, it poses significant risks to data privacy, clinical safety, and regulatory compliance.

Objective:

This study explores how physicians use Shadow AI in their work.

Methods:

We conducted a cross-sectional survey of physicians employed in Swedish healthcare organizations (N=357; response rate ~64%). Data were collected between December 2023 and January 2024 via a verified online panel. We conducted a qualitative content analysis of free-text responses on the use of unauthorized AI tools. We applied theoretical lenses from the sociology of professions and paradox theory to interpret the findings.

Results:

Analysis revealed that physicians use Shadow AI for several purposes, which we grouped into four categories: Clinical work and decision-making; Administrative work; Research and professional development; and Technological interest and curiosity. More specifically, Shadow AI is used as a colleague and second opinion for clinical decision support (e.g., differential diagnoses and rare cases), administrative tasks such as patient communication and documentation, and research aimed at staying up to date and exploring developments in generative AI (GAI).

Conclusions:

Shadow AI used by physicians presents both opportunities and risks for healthcare professionals and organizations. On one hand, Shadow AI indicates gaps, where formal hospital systems may fail to meet healthcare professionals’ needs, and signals a way for physicians to strengthen their experience-based knowledge. Shadow AI represents a renegotiation of professional boundaries, as physicians bypass institutional constraints to maintain professional efficacy. On the other hand, healthcare organizations must move beyond prohibition toward “sandbox” environments that enable safe exploration, balancing the innovation potential of Shadow AI with strict adherence to emerging regulations such as the EU AI Act.