Healthcare AI · AI Governance Framework
Psychiatric AI Documentation Startup
A pre-launch psychiatric AI tool that transcribes clinician dictation, generates structured clinical notes, and evaluates those notes against insurance payer documents to support prior authorization—operating in one of the highest-stakes environments in clinical AI.
The Challenge
A founding team preparing for clinical pilot needed an honest governance assessment before any real patient data was processed. The product handles PHI, interfaces with payer systems, and produces outputs that directly affect patient care decisions—with no governance framework in place.
A CompassAI diagnostic surfaced the pre-launch gaps. The engagement expanded into a full five-pillar AI Governance Framework built to carry the product into pilot.
Key Considerations
- Psychiatric patients are among the most vulnerable in clinical care. Every governance decision carries heightened ethical and legal weight.
- Three output sources—clinician dictation, model inference, payer policy evaluation—must be distinguishable at review, not collapsed into a unified output.
- Mandatory affirmative approval engineered into the product. No note finalizes without deliberate clinician action.
- Clinician attestation on every finalized note. Accountability explicit, traceable, and auditable.
- Critical HIPAA gap: no signed BAA with Azure cloud provider. Identified as the highest-priority pre-launch action item.
- Audit log architecture assessed for full note provenance: model output, auto-populated fields, and clinician changes—individually attributable.
- Cyber insurance co-design: governance documentation and incident response protocols built to satisfy both regulatory and underwriter review simultaneously.
Governance Profile at a Glance
Deliverables
CompassAI Assessment
Five-pillar governance diagnostic surfacing pre-launch gaps and prioritized action items.
AI Governance Framework v2.0
Full five-pillar framework: current posture, identified gaps, planned actions, and recommended protocols.
Product Design Guidance
Source delineation architecture for the clinician UI; mandatory approval flow; attestation language.
Cyber Insurance Alignment
Governance deliverables mapped to cyber insurance requirements for coordinated pre-launch review.
"Working through the governance framework before we deployed gave us a level of confidence we would not have had otherwise. Responsible AI governance became integral to how we thought about what we were building, not just how we documented it."
Founder, Psychiatric AI Documentation StartupOutcomes
Full governance framework in place before the first clinical pilot participant is enrolled—shaping product architecture, not documenting it retroactively.
Governance built into the product itself: mandatory approval step, source-distinguished review interface, and clinician attestation on every output.
BAA identified as top pre-launch action item, prioritized across both HIPAA compliance and cyber insurance underwriting simultaneously.