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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.

The integration of artificial intelligence (AI) into healthcare systems and analytics represents a transformative shift toward more efficient, personalized, and predictive clinical practices. However, this evolution necessitates robust governance frameworks to ensure transparency, mitigate biases, and enable continuous lifecycle monitoring. This narrative review synthesizes recent literature on AI governance in healthcare, focusing on systems-level infrastructure and clinical analytics. Drawing from peer-reviewed publications, we examine how AI tools enhance healthcare delivery through data-driven insights while addressing ethical, regulatory, and operational challenges.Central to AI governance is transparency, which involves making algorithmic processes interpretable to clinicians and stakeholders. Studies highlight the need for explainable AI models in clinical decision-making, where opaque “black-box” systems can undermine trust and accountability. For instance, frameworks for implementing machine learning in healthcare emphasize ethical considerations, such as disclosing model limitations and decision rationales to prevent misinformed clinical actions. Bias mitigation emerges as a critical pillar, with research demonstrating how algorithmic biases in electronic health records can perpetuate health disparities, particularly among underrepresented populations. Strategies include proactive monitoring of algorithms for equity, incorporating diverse datasets during development, and post-deployment audits to detect and correct biases.Lifecycle monitoring models ensure sustained performance and safety of AI systems over time. This encompasses ongoing evaluation, recalibration, and governance structures that adapt to evolving clinical environments. Nationwide initiatives propose AI assurance laboratories to standardize monitoring, while institutional guidelines advocate for step-by-step implementation to avoid “AI winters” caused by unaddressed failures. In analytics contexts, large AI models facilitate health informatics by processing vast datasets for predictive analytics, yet they require governance to handle challenges like data privacy and model drift.The review structures its synthesis around healthcare systems’ end-to-end loops: from data ingestion to intelligent decision support and closed-loop interventions. It integrates cross-study analyses to propose original interpretive models for governance, emphasizing human-AI collaboration in clinical workflows. Key findings underscore the importance of multidisciplinary approaches, combining technical, ethical, and regulatory perspectives to foster responsible AI adoption. Ultimately, effective governance not only enhances patient outcomes but also builds public trust in AI-driven healthcare. This synthesis highlights gaps in current practices and advocates for integrative monitoring systems to realize AI’s full potential in equitable healthcare delivery.

Federated learning (FL) is promoted as a privacy-preserving method for training machine learning models across healthcare institutions without sharing patient data, with growing use in medical imaging, electronic health records, and rare disease research. This critical review examines FL studies from 2017–2024, focusing on privacy guarantees, statistical heterogeneity, communication efficiency, and real-world clinical deployment. A structured search of PubMed, IEEE Xplore, arXiv, and Google Scholar was conducted using relevant FL and healthcare terms, including studies addressing privacy, heterogeneity, communication, or deployment. Reported privacy guarantees are often overstated, with most studies relying on FedAvg without differential privacy. Statistical heterogeneity in non-IID settings remains largely unresolved. Fewer than 5% of studies report real-world deployment, typically at very small scale. A significant gap exists between FL research and clinical application. Current methods fall short of healthcare-grade privacy and real-world constraints, limiting readiness for high-stakes clinical use.