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Appointment cancellations undermine clinic efficiency, disrupt continuity of care, and reduce access for patients waiting for limited appointment slots. Many cancellations may be preventable when risk is recognized early enough for staff to intervene with reminders, rescheduling support, transportation assistance, or telemedicine conversion. Existing appointment-risk models often emphasize historical attendance and demographic information while underusing scheduling notes, patient communication history, weather conditions, and transportation barriers. They also frequently provide risk scores without patient-specific explanations that staff can translate into meaningful outreach. This article proposes an explainable machine learning framework for predicting preventable appointment cancellations before the appointment occurs. The framework is designed to identify not only which appointments may be at risk, but also why the cancellation risk is elevated. The proposed framework uses a gradient-boosted classification model trained on structured scheduling variables, prior attendance behavior, communication history, weather-linked features, transportation indicators, and natural language processing outputs from scheduling notes. SHAP-based explanation layers would decompose each prediction into interpretable drivers that can be reviewed by scheduling staff, clinic managers, and governance teams. Conceptually, the framework would output a cancellation risk score together with a natural-language explanation of the dominant drivers. These outputs could support targeted interventions such as reminder escalation, proactive rescheduling, transportation support, or conversion to a virtual visit when appropriate. An explainable framework for preventable appointment cancellation prediction could shift patient access management from reactive backfilling toward proactive retention. By combining heterogeneous access signals with transparent attribution, clinics could better align outreach resources with patient-specific barriers.

Patient access to timely, appropriate care remains a persistent challenge for health systems, affecting clinical continuity, patient experience, and operational performance. Artificial intelligence has been proposed as a means of automating and optimizing navigation functions from scheduling to follow-up coordination. This systematic review examined artificial intelligence applications for care navigation and patient access across scheduling optimization, referral management, eligibility screening, digital front-door tools, and follow-up coordination. The review also assessed implementation maturity, evaluation approaches, and equity-related reporting. A PRISMA 2020-compliant search was conducted across PubMed, Scopus, IEEE Xplore, and Web of Science for publications from 2017 through 2025. Dual screening, structured data extraction, risk-of-bias assessment, and narrative synthesis were used to characterize the evidence. The literature was concentrated in scheduling optimization, particularly no-show prediction and operational appointment management, and in digital front-door tools such as symptom checkers and triage chatbots. Referral and eligibility applications were emerging, while follow-up coordination models often overlapped with readmission and care-transition prediction. Few studies reported prospective implementation, comparative deployment outcomes, or equity impacts. Artificial intelligence-driven patient access tools appear technically robust for isolated tasks, but evidence that they improve integrated, end-to-end navigation remains limited. The field requires stronger prospective evaluation, equity assessment, and implementation reporting.

Patient access performance—scheduling efficiency, referral completion, wait times, and appointment attendance—varies widely across healthcare organizations. These organizations rarely learn from each other because operational data are sensitive, locally governed, and often competitively protected. Isolated access analytics limit the discovery of generalizable patterns and prevent hospitals from learning from peer institutions with different patient populations and workflows. No current operational platform fully enables multi-hospital learning about patient access without exposing patient-level scheduling, referral, and attendance data. This article proposes a privacy-preserving AI platform that uses federated learning and secure aggregation to support cross-hospital modeling of scheduling demand, referral completion, appointment lead time, and no-show risk. Raw data remain within each participating hospital, while only protected model updates or aggregate statistics contribute to shared learning. The platform consists of local data adapters, standardized access-feature pipelines, a federated model trainer, a secure aggregation layer, differential privacy controls, and local operational dashboards. Each hospital receives a shared model that can be adapted locally while preserving institutional data control. The framework could enable hospitals to benefit from broader operational learning while maintaining confidentiality, competitive neutrality, and governance accountability. It would be expected to support more consistent access analytics across heterogeneous health systems without requiring centralized pooling of sensitive records. Privacy-preserving AI could support a new collaborative analytics paradigm for patient access and healthcare operations. Such platforms should be evaluated through multi-institutional pilots that assess technical feasibility, governance readiness, privacy protection, and operational usefulness.