Elion has released The AI Governance Playbook: Insights and Tools for Building Oversight That Works, a comprehensive analysis of the current state of AI governance at prominent health systems across the United States. The report reveals that most health systems’ AI governance committees are already falling behind as project requests surge across clinical and operational workflows.
Despite significant investment in standing up governance programs over the past 12-18 months, AI project submissions now outpace governance committee decisions nearly 3 to 2, creating a widening backlog that slows safe deployment and strains operational leaders.
“Health systems have built the governance structures. Now they’re realizing those structures need the staffing, speed, and scope to match real-world AI demand,” said Bobby Guelich, CEO and Co-Founder of Elion. “As AI is woven into more parts of care and operations, governance must keep pace or systems risk losing meaningful oversight.”
Based on interviews with leaders from more than 20 of the nation’s leading health systems and a quantitative survey benchmarking committee operations, the report identifies three dynamics driving the backlog:
- AI project volume is accelerating faster than governance can process it. Most systems report 4-6 new AI submissions per month, but half finalize less than 3 decisions, creating an expanding queue of unreviewed tools.
- Staffing remains critically insufficient for the level of oversight required. Even as two-thirds of health systems involve 15+ people in governance work, over 75% rely on just two or fewer dedicated FTEs to run the program day to day.
- Leaders overwhelmingly say they don’t have enough resources to govern AI appropriately. More than 60% describe their governance resources as insufficient, particularly for ongoing monitoring and local validation.
As AI expands across documentation, clinical decision support, scheduling, denials management, imaging workflows, and more, leaders report a growing urgency to scale their processes beyond ad hoc committee structures.
Alongside its report, Elion has released in The Playbook a toolkit produced in partnership with Dr. Sarah Gebauer of Validara Health, a physician and AI researcher. The Toolkit highlights emerging best practices from early movers, including templates for intake questionnaires, risk-tiering matrices, contracting considerations, and more.
The AI Governance Playbook, including The State of AI Governance Report and Toolkit are available at https://aigovernance.elion.health/.
About Elion
Elion helps provider organizations vet emerging healthcare technology. Through the industry’s most comprehensive mapping of the healthcare technology landscape, high-quality research, and executive summits that bring providers and vendors together, Elion enables health system leaders to evaluate solutions with clarity and confidence.
About Dr. Sarah Gebauer
Dr. Sarah Gebauer is a Stanford-trained physician and national expert in healthcare AI governance, validation, and safety. A former RAND Corporation researcher, she developed strategies for evaluating AI performance and reliability in national security and other high-stakes environments. As founder of Validara Health, she brings that rigor to healthcare, helping organizations assess the safety, reliability, and clinical integrity of AI systems. Dr. Gebauer writes widely on governance and the future of clinical AI.
View source version on businesswire.com: https://www.businesswire.com/news/home/20251118985626/en/
Even as two-thirds of health systems involve 15+ people in governance work, over 75% rely on just two or fewer dedicated FTEs to run the program day to day.
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