TY - JOUR T1 - A Causal Inference–Driven Treatment Effect Governance Model for Observational Clinical Systems AU - Sven Larsson AU - Erik Johansson AU - Anna Nilsson JF - Journal of Artificial Intelligence for Healthcare Systems JO - J. Artif. Intell. Healthc. Syst. SN - 3149-8981 Y1 - 2026 VL - 5 IS - 1 SP - 44 N2 - In the realm of observational clinical systems, where electronic health records (EHRs) and real-world data dominate decision-making pipelines, robust treatment-effect estimation remains a critical challenge. This conceptual manuscript introduces the treatment effect integrity network (TEIN), a novel governance model driven by causal inference principles to orchestrate monitoring, adjustment, and validation of treatment effects within heterogeneous healthcare analytics infrastructures. By integrating causal diagrams, counterfactual reasoning, and dynamic adjustment mechanisms, TEIN addresses biases inherent in observational data, such as confounding and selection effects, without relying on empirical datasets or model training. The architecture emphasizes interoperability across clinical AI systems, facilitating seamless integration into EHR intelligence ecosystems and decision-support pipelines. Key components include a causal mapping layer for identifying potential biases, a governance orchestration module for real-time effect monitoring, and a feedback topology that propagates integrity signals through clinical workflows. Theoretical formulas are presented to interpret risk propagation in causal chains and governance load under varying observational constraints. This model advances AI governance in healthcare by providing a structured approach to maintaining the reliability of treatment effects, ultimately supporting ethical deployment in observational settings. Through literature synthesis, we highlight alignments with existing clinical AI frameworks while underscoring TEIN’s unique focus on causal-driven governance. Implications for clinical practice include enhanced decision confidence and reduced monitoring burdens in resource-constrained environments. UR - https://cirpublications.com/a120078888 ER -