Currently submitted to: JMIR AI
Date Submitted: Feb 26, 2026
Open Peer Review Period: Mar 10, 2026 - May 5, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Artificial Intelligence in Hospital Systems: The Expanding Data Ecosystem and the Need for Ethical Governance
ABSTRACT
Abstract Artificial intelligence (AI) is transforming hospital and health care systems by enabling new forms of clinical decision support, operational forecasting, diagnostic automation, and remote physiological surveillance. These facets depend on unprecedented volumes of clinical, behavioral, and operational data that hospitals increasingly share across complex networks involving electronic medical record vendors, cloud infrastructure providers, device manufacturers, and third-party AI developers. Although these partnerships have accelerated technological innovation and generated significant improvements in efficiency and clinical practice, they have also introduced new risks in privacy, cybersecurity, data ownership, equity, algorithmic transparency, and environmental sustainability. This paper examines the expanding hospital data environment underlying AI systems, explores the implications of vendor-mediated data flows, identifies population-level and systemic risks, and proposes a multi-layered governance framework grounded in public health ethics. This analysis argues that because hospital AI systems are dynamic and operate at scale, transparent, equity-driven, and accountable data governance is essential to prevent the amplification of disparities and erosion of public trust in digital health technologies.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.