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Generative artificial intelligence (GenAI) has emerged as a transformative force in healthcare systems, enabling advanced analytics, personalized interventions, and streamlined governance frameworks. This narrative review synthesizes recent literature on GenAI’s integration into healthcare infrastructures, emphasizing systems governance, safety protocols, and accountability mechanisms. We explore how GenAI enhances clinical decision-making, data analytics, and closed-loop systems while addressing ethical, regulatory, and operational challenges.At the core of healthcare systems, GenAI facilitates intelligent analytics by generating synthetic data for training models, simulating patient outcomes, and optimizing resource allocation. Governance frameworks are critical for ensuring responsible deployment, with studies highlighting the need for institutional guidelines that mitigate risks such as bias amplification and data privacy breaches. Safety considerations encompass algorithmic transparency, error detection in generative outputs, and human oversight in clinical loops. Accountability extends to lifecycle management, from model development to post-deployment monitoring, as evidenced by global initiatives and regional models like those in the GCC.The review delineates the landscape of GenAI applications in healthcare analytics, including predictive modeling for chronic disease management and real-time decision support. We propose an original systems-level framing that integrates data ingestion, inference generation, intervention deployment, and feedback recalibration under governance umbrellas. This synthesis reveals gaps in current infrastructures, such as the lack of standardized AI guardians for information overload and the challenges of scaling enterprise AI.In examining intelligent clinical decision systems, we highlight architectures that fuse GenAI with electronic health records (EHRs) for closed-loop operations, where generative models inform adaptive interventions. Ethical considerations are woven throughout, advocating for principles adapted from military contexts to healthcare. The adoption of GenAI in US hospitals underscores its potential for inpatient summaries and chronic care, yet calls for regulatory oversight to align with Helsinki declarations.Ultimately, this review positions GenAI as a cornerstone for accountable healthcare systems, urging interdisciplinary collaboration to balance innovation with safety. By synthesizing governance models, safety protocols, and accountability structures, we provide a roadmap for sustainable integration, fostering equitable health outcomes in an AI-augmented era.

Synthetic electronic health record (EHR) data generation has emerged as a potential solution to balancing clinical data accessibility with patient privacy, using generative artificial intelligence to simulate tabular, longitudinal, and textual health records without exposing identifiable patient information. This critical review, informed by PRISMA-ScR methodology, examines studies published between 2017 and 2025 focusing on generative models for synthetic EHR creation, with particular attention to privacy risks, data fidelity, downstream task utility, and ethical or regulatory considerations. A total of 67 studies were included after systematic screening, showing a dominance of GAN-based approaches alongside growing use of diffusion models and large language models in recent years, although privacy assessment and benchmarking practices remain inconsistent. Overall, the evidence suggests that while synthetic EHR data can facilitate data sharing, research, and model development, achieving a balance between realism, utility, and privacy remains challenging, as high statistical fidelity does not necessarily translate into clinical usefulness and strong downstream performance does not ensure adequate privacy protection.

Generative artificial intelligence (AI), including GANs, VAEs, and diffusion models, is increasingly used for synthesizing and enhancing medical images, helping address challenges such as limited data, expensive acquisition, and rare disease representation. This systematic review examines studies on generative AI methods for MRI, CT, X-ray, and pathology image synthesis from 2017 to 2026, focusing on synthesis tasks, evaluation strategies, and clinical utility. A PRISMA 2020-compliant search of PubMed, IEEE Xplore, Scopus, and Web of Science identified peer-reviewed research on generative models for medical image synthesis, augmentation, harmonization, or cross-modality translation. Findings show a shift from GAN-based methods to diffusion models post-2022, with MRI and CT studies emphasizing cross-modality translation, and X-ray and pathology studies focusing on augmentation and diagnostic utility. Despite GANs' continued dominance, diffusion models are gaining traction for improving image fidelity and diversity. However, evaluation practices remain inconsistent, with limited inclusion of clinically relevant assessments. This review follows PRISMA 2020 guidelines and provides a narrative synthesis of the evidence.