Beyond Model Development in Healthcare AI: Post-Development Robustness, Post-Deployment Monitoring, and Lifecycle Governance—A Scoping Review of Reviews

Résumé fourni par la source

Background: Clinical artificial intelligence (AI) is rapidly moving from retrospective model development into prospective evaluation, implementation, and routine care. Existing reviews have addressed specific aspects of this transition, including monitoring, drift, implementation, governance, and human–AI interaction; however, these bodies of work remain methodologically and conceptually fragmented across different review traditions. Methods: We conducted a scoping review of review-level and review-oriented literature. We searched MEDLINE, Embase, Scopus, and Web of Science Core Collection from database inception to 28 February 2026. We charted review characteristics and conducted an inductive thematic synthesis of extracted review-level findings, while distinguishing operational, deployment-proximal, methodological, and conceptual/governance-oriented evidence. Results: We included 25 review-level publications spanning systematic, scoping, methodological, narrative, and governance-oriented reviews. Three major themes emerged. First, clinically important risks were consistently framed as socio-technical rather than purely algorithmic: trustworthiness depended not only on technical performance, but also on fairness, transparency, workflow fit, human oversight, and organisational readiness. Second, the included review literature consistently recommended post-deployment monitoring but showed limited operational maturity; monitoring methods, action thresholds, fairness surveillance, and corrective responses were weakly standardised, and mature evidence from activated systems in routine care remained sparse. Third, trustworthy implementation was increasingly framed as a lifecycle governance challenge extending beyond procurement and initial validation to include local validation, subgroup auditing, drift detection, controlled updating, incident response, and, where necessary, rollback or retirement. Discussion: The review literature suggests a persistent normative–operational gap, meaning that recommendations about what trustworthy clinical AI should require have advanced faster than evidence on how monitoring, updating, and governance are implemented in routine care. The strongest unresolved challenge is therefore not principal generation alone, but the translation of monitoring and governance expectations into actionable operational systems. Conclusions: Post-development trustworthiness in clinical AI should be understood as a lifecycle property, not a one-time technical achievement. Future work should prioritise stronger operational evidence, clearer reporting of deployment-proximal and post-deployment evaluation, methodological standardisation of monitoring metrics and thresholds, implementation research on feasible governance models, and evaluation frameworks for assessing post-deployment safety, fairness, accountability, and sustainability.

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