Table 1 Readiness questions for healthcare systems, developers, and funders considering AI investment

Staff

• Does the healthcare system employ a diverse range of trained professionals in sufficient numbers? Are these professionals compensated equitably across all levels of hierarchy?

• Does the healthcare system have standardized, dedicated time and resources for training and upskilling clinical staff?

• How is the healthcare system planning for anticipated changes in staffing needs, roles, and skill requirements over a clear time horizon? To what extent is the planning process collaborative, allowing for meaningful engagement of the clinical staff?

• Has leadership conducted a systems-level analysis to identify who may benefit (financially, socially, politically, or otherwise) from the introduction of new health technologies, and who might be disadvantaged? Are there plans to track, measure, and mitigate the impact (both intended and unintended) of these technologies on staff?

• When considering AI tools procurement, where are the technologies sourced from? Are they co-created with relevant local healthcare staff, and is training inclusive of all relevant personnel? Are global or regional differences considered in training, implementation, and oversight?

• What mechanism does the healthcare system have to ensure the transparency and intelligibility of algorithmic outputs? How will healthcare professionals be trained and empowered to review, question, and challenge algorithmic decisions?

Stuff

• Does the healthcare system have the essential materials and tools needed to provide high-quality care for all patients?

• Does the healthcare system have the essential technical materials, such as consistent electricity, internet access, computer hardware and more?

• Does the healthcare system have the means to share and integrate data with other local or regional healthcare systems?

• Are the tools for providing care integrated into an automated system to collect and analyze data?

• Does the healthcare system have a robust data infrastructure to provide secure, scalable data storage of large volumes of health data?

• Does the healthcare system have privacy and cybersecurity protocols in place?

• Does the healthcare system have an efficient supply chain and resource management plans?

• Does the healthcare system have local or regional level manufacturing of medical supplies?

Spaces

• Does the healthcare system have equipped, clean, physical facilities for providing care for comprehensive medical services?

• Does the healthcare system have safe digital spaces, with reliable internet connectivity and cloud access?

• Does the healthcare system have protocols in place to ensure the safety of both physical spaces (sufficient privacy, supportive services e.g. for those afraid of accessing care or dealing with stigma or in need of additional services) and digital spaces (data protection, data privacy, encryption and authentication protocols, regular audits)?

Systems

• Have the set of systems that comprise and are comprised by your healthcare system been documented and mapped (including social relationships, political leadership, governance, IT and resources, as well as the local histories that contribute to the ongoing production of systemic injustices and disparities)?

• Does the healthcare system regularly conduct audits and analyses at micro, meso, and macro levels to track health outcomes, quality of service, and patient experience?

• Is leadership clear about where the greatest staffing needs are to improve care delivery?

• Does the healthcare system have clear, established, fit-for-purpose processes and standards for implementing new healthcare technologies? Are these rigorous and adaptable to new technologies like AI (e.g., including steps for local validation and monitoring)?

• Is there a clear financing plan for the introduction of new technologies, including an analysis of areas within the healthcare system that may face reduced funding or be deprioritized as a result?

Support

• Does the healthcare system have processes in place to support patients and community members comprehensively?

• Are there systems to provide social support—such as food, housing, education, employment—for staff, patients, and community members?

• Are there regional, local, and system-wide mechanisms in place to reduce poverty and support vulnerable and marginalized groups?

• Is the healthcare system actively implementing initiatives to address disparities in health outcomes?