Nobody signed for them.
Thirty million consultations a month.
The vendor knew before the hospitals did.
A third of the nine thousand physicians
at New York's Mount Sinai's
were already regular users of OpenEvidence.
Executives learned it
in a meeting with the startup last year.
The institution had not adopted the tool.
Not yet.
The physicians already had.
One at a time.
The New York Times reported it in June.
More than half of American physicians
now use OpenEvidence.
Double the volume
of six months before.
No committee.
No charter.
No named owner.
And the tool helps.
One doctor told the Times
it forces you to think more deeply
about your own thinking.
That seat is still held.
Mount Sinai has since signed
an enterprise deal with OpenEvidence.
Built into the Epic EHR.
Formalized access.
Still no name on the call.
Then the Times found a small hospital.
It pays for specialist consults.
A specialist consult
arrives with a name on it.
A credentialed person
who answers for the recommendation.
The hospital leans on OpenEvidence instead.
Cheaper. Faster.
Specialists in your pocket,
the physician said.
Here is what the pocket does not carry.
The name.
The specialist who answered
when the recommendation was wrong.
The consult still happens.
The answer still arrives.
The person who stood behind it
is gone.
Assistance keeps the decision
with a named owner.
Substitution keeps the answer
and loses the owner.
The two look identical
in the chart.
↳ The Governance Owner
names what the app is authorized to answer.
↳ The Decision Owner
holds the call the app cannot.
↳ The Handoff between them
is written before the substitution,
not after the harm.
The Accountability Gap™ (TAG™)
does not open because physicians use AI.
It opens when the consult keeps arriving
and the name stops coming with it.
Formalized or not,
The decision still needs a name on it.
Half the physicians in America
adopted a consultation layer
before their institutions
knew it was in the building.
Your medical staff is already using it.
Did your institution find out
from its own governance,
or from the vendor?
Mo Johnson, MD MBA is a cardiothoracic surgeon and the founder of GPe Research. Field Notes are short dispatches from the clinical AI accountability frontier, published alongside the MedicoVigilance™ newsletter at medicovigilance.org.
Follow the work on LinkedIn: linkedin.com/in/mo-johnson