Health systems are not stepping into artificial intelligence from a place of calm or control. In the United States, spending now exceeds $4.5 trillion, with a significant share tied up in administrative work that adds complexity more than clarity. Clinicians are caring for more patients, navigating more data and making more decisions under pressure than ever before. The system is stretched. Artificial intelligence is entering at a moment when change is no longer a choice.

The discussion drew on the experience of three leaders who are not observing this shift. They are guiding it. Hal Wolf leads HIMSS, influencing digital health policy and implementation across more than 100 countries. Isaac Kohane, MD, PhD, Chair of Biomedical Informatics at Harvard Medical School, has spent four decades defining how data informs clinical care. Ran Balicer, MD, Chief Innovation Officer at Clalit Health Services, operates within one of the world’s most integrated health systems, where data and care are aligned across generations.

These are not just star panelists. They are system-wide architects.  What emerged from the hour-long conversation was not what artificial intelligence can do. It was a recognition that it is already doing more than most systems are prepared to guide and govern.

Dr. Kohane captured the tension immediately. “I think that we have to worry about the fact that we’re going both too slow and too fast.”

That statement reflects a reality many leaders feel but rarely express. Governance takes time because it must. Patient safety, validation and accountability require structure. Practice moves in real time. Clinicians do not have the luxury of waiting for perfect systems.

“They’re so desperate to do right by their patients to use other resources,” Dr. Kohane adds.

That instinct is not a weakness. It reflects a commitment to doing what is right for the patient. When clinicians turn to external AI tools, they are seeking clarity, speed, and confidence in their decisions. Artificial intelligence is already present at the point of care, shaping how physicians assess information, validate thinking, and move forward. The system is not adopting AI. The system is catching up.

This creates a condition that is difficult to measure and even harder to manage. Different clinicians use different ChatGPT platforms. Those tools produce different answers. Different assumptions shape those answers. Over time, consistency erodes. The system begins to operate with multiple definitions of truth (and the risk of varied outcomes).

Dr. Kohane’s warning is not about misuse. It is about misguided permanence. “The worst outcome will be if the worst parts of medicine get concrete poured over it, by AI.”

Artificial intelligence does not fix a system; without leadership, it accelerates the integration of incorrect assumptions. If workflows are inefficient, they become more efficiently inefficient. If bias exists in data, it becomes more precise. If fragmentation defines care, it scales.

This is not a failure of technology. It is a mirror held up to system-wide leadership.

Hal Wolf, among the health sector’s leading policy and operational voices, grounded this moment in proven experience. Health care has seen this pattern before. When internet connectivity entered hospitals, clinicians moved faster than governance. They created access where it was needed. Systems responded later. Risks were discovered after adoption.

Artificial intelligence now follows that same trajectory, though at far greater speed and with far greater consequences. Web connectivity gave quick access to information. Artificial intelligence influences how that information is interpreted and acted upon.

“We have to go faster,” Mr. Wolf said. “But there needs to be structure around it.”

That is the leadership challenge of this moment. Speed without structure creates exposure. Structure without speed creates irrelevance. The tension between the two is not something to resolve. It is something to manage continuously.

The industry has predictably responded to artificial intelligence. It has started where risk is lowest and return is clearest. Documentation, scheduling and revenue cycle optimization have become the entry points. These applications reduce burden and improve efficiency. They are necessary. However, they are not transformational.

The shift occurs when artificial intelligence moves into clinical decision-making. At that point, the question is no longer whether the system works. The question becomes whether it should be trusted.

Who owns a decision informed by an algorithm? How is accuracy validated? What happens when a clinician disagrees with a recommendation? These are not technical questions. They are questions of accountability. Artificial intelligence does not assume responsibility. It does not carry consequence. That remains with leadership.

Dr. Balicer reframed the conversation, shifting how the room thought about artificial intelligence. “There’s no such thing as AI neutrality. Algorithms are just opinions embedded in code.”

That insight is easy to acknowledge and difficult to operationalize. Every model reflects choices. What data is included? What outcomes are prioritized? What trade-offs are accepted? Those decisions are embedded in the system, shaping how it interprets information.

When a health system adopts an AI tool, it is not simply implementing technology. It is adopting a perspective.

At Clalit Health Services, alignment across payer and provider creates a system where priorities are consistent. Even there, external AI models introduce new assumptions. Those assumptions may not align with the system’s goals. If leadership does not define its own values, it inherits someone else’s.

This becomes real in proactive care. Artificial intelligence enables systems to identify patients at risk before they present. It allows for earlier intervention, often improving outcomes.

It also creates a new kind of pressure. “The toughest choice is what not to do,” Dr. Balicer said.

That statement deserves more attention than it receives. Health care has been built around responding to need. Artificial intelligence introduces the ability to anticipate it. When every patient can be flagged, every risk predicted and every intervention suggested, the system is no longer constrained by insight. It is constrained by capacity.

Artificial intelligence expands what can be done. It does not expand who can do it. Leadership becomes the act of choosing who does what based on validated data.

There is a moment that captures this shift. Imagine a primary care physician starting the day not with a schedule of patients who have called for appointments, but with a list generated by AI identifying individuals who are likely to experience clinical complications in the next six months. Some will develop chronic conditions. Some will require hospitalization. Some can be helped now – preventively.

The physician cannot see them all. Artificial intelligence expands what is possible. Leadership decides what is essential and permissible.

The industry often responds to complexity with activity. Organizations pilot, test and explore. They engage broadly without committing deeply. This creates motion. It rarely creates progress. Pilots are nothing more than experiments. At some point, leadership must decide what to scale, what to stop and what defines value.

Hal Wolf grounded the conversation in discipline. Without a defined, shared objective, effort becomes noise. Pilots create learning, though they often avoid decision-making. Leadership requires clarity. What problem are we solving? What outcome defines success? What are we willing to prioritize? Without those answers, artificial intelligence adds another layer of complexity to an already complex system.

Dr. Kohane brought the conversation back to the discipline of leadership. It cannot remain abstract. It must be informed by experience.

“Go and pay a few bucks and use three or four of the models… get a feel for what this does,” Dr. Kohane advised.

That is not a call for technical fluency. It is a call for leadership proximity. Leaders cannot guide what they do not understand. Artificial intelligence does not behave consistently across models. It produces different answers, shaped by different assumptions. Without direct engagement, those differences remain hidden, and leadership becomes removed from the very decisions it is responsible for guiding.

This is where many organizations hesitate. Artificial intelligence feels complex and complexity invites delegation. At this moment, delegation creates distance. Leadership is required to move closer, not further away.

Artificial intelligence is not reducing the role of leadership. It is redefining it.

This is not a gradual transition. It is already underway. Artificial intelligence is embedded in workflows, shaping decisions and influencing behavior in real time. The system is adapting whether leadership is ready or not.

The question is no longer whether artificial intelligence will shape the future of health. It will. The question is whether leadership will shape how it is applied.

Artificial intelligence will not fix health. It will scale whatever we allow it to touch. The question is whether it will scale what is best in health or what we have yet to fix.

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History, however, offers a useful caution. Breakthrough technologies in medicine rarely achieve their full potential simply because they exist. Their real impact depends on whether the institutions responsible for health-care delivery know how to adopt them wisely, integrate them responsibly and align them with their mission to improve patient health.

Artificial intelligence now stands at that same threshold. The industry has moved beyond fascination with what algorithms can do and entered a more demanding phase: determining how these tools should be evaluated, governed, and integrated into the environments where care is delivered. At the same time, some health professionals are turning to AI – not to augment their knowledge – but assuming the information is patient-care ready.

Across the health ecosystem, leaders are discovering that the most important questions about artificial intelligence are not technological. They are organizational, ethical and operational. Which AI systems genuinely improve clinical decision-making? Which tools strengthen the efficiency of hospitals and health systems? Which innovations introduce complexity without delivering measurable benefit?

Answering those questions requires a perspective that bridges policy leadership, real-world care delivery, and the scientific foundations of biomedical informatics. That convergence of experience sits at the center of a “Views From the Top” mainstage discussion at the HIMSS Global Health Conference & Exhibition, where some 35,000 leaders whose work spans the global health ecosystem will examine how organizations can recognize the true value proposition of artificial intelligence applications before embedding them into health-care systems.

The perspectives shaping this discussion reflect three essential dimensions of responsible artificial intelligence in health: governance frameworks that guide innovation, operational insights from large-scale health care delivery, and scientific rigor grounded in biomedical informatics. Together, these vantage points illuminate the path from technological promise to practical value.

Governing Innovation in a Rapidly Changing Health Ecosystem

Digital transformation in health rarely succeeds simply because technology exists. It succeeds when organizations develop leadership frameworks capable of evaluating innovation, managing risk and aligning new tools with patient-centered goals.

Few leaders have observed the evolution of digital health across as many national systems and institutional environments as Hal Wolf, president and chief executive officer of HIMSS, Ran Balicer, MD, PhD, chief innovation officer of Clalit Health Services and Isaac Kohane, MD, PhD, chair of biomedical informatics at Harvard Medical School. The three will step onto the mainstage at HIMSS to share their “View from the Top” in a session titled: “Recognizing the ‘Value Proposition’ Criteria While Selecting AI Applications.”

Through his work with global government health ministries, hospital networks, and technology innovators worldwide, Wolf has consistently emphasized that technological progress must be anchored in governance and trust.

“Digital health transformation is not about technology alone. It is about leadership, governance, and the trust that allows innovation to improve care,” Wolf has said in discussions about global digital health transformation.

Artificial intelligence intensifies this leadership challenge because its influence extends far beyond traditional clinical tools. AI systems increasingly operate across multiple layers of healthcare delivery. Some applications assist clinicians by analyzing medical data or suggesting treatment options. Others function within hospitals’ and health systems’ operational infrastructure, helping manage patient flow, prioritize diagnostic reviews, and allocate scarce resources.

These operational algorithms rarely capture headlines; however,  they shape the environment in which health care is delivered. Decisions about which cases are reviewed first, how clinicians allocate their attention, and how health systems manage capacity can profoundly influence patient outcomes.

For leaders responsible for health systems, artificial intelligence cannot be treated as simply another technological upgrade. It must be evaluated through governance structures capable of understanding how algorithms function, what assumptions shape their recommendations, and how their use aligns with institutional priorities.

Without that oversight, innovation risks amplifying complexity rather than improving care. Instead of informing, it can spread misinformation.

Aligning Artificial Intelligence With the Values of Medicine

Governance provides the policy foundation for responsible adoption of artificial intelligence, but real-world implementation reveals a second challenge: ensuring that AI systems operate effectively within healthcare delivery itself.

Large population health systems increasingly use advanced analytics to anticipate risk, manage chronic disease, and allocate clinical resources across diverse communities. Within these environments, artificial intelligence is no longer a theoretical innovation. It is already influencing how health organizations prioritize patients, coordinate care and deploy limited resources.

That operational perspective is central to Ran Balicer, MD, PhD, of Clalit Health Services, one of the world’s most advanced data-driven health systems. The Clalit integrated infrastructure connects hospitals, clinics, and community health programs through longitudinal datasets that support predictive analytics at the national scale.

Experience within such systems reinforces an important insight: artificial intelligence models do not function independently of human judgment. They reflect priorities embedded in their design and the assumptions guiding their deployment.

“Algorithms are opinions embedded in code,” Balicer has observed in discussions about the role of artificial intelligence in population health.

In practice, this means that AI systems interpret clinical data through frameworks shaped by human choices. The way a model defines risk, prioritizes cases, or recommends interventions reflects decisions about what matters most within a healthcare environment.

Those decisions carry ethical implications. When artificial intelligence helps determine which patients receive immediate attention or which cases are escalated for further review, transparency about how algorithms function becomes essential to maintaining trust among clinicians and patients alike. The scientific frontier of health-care AI reinforces that concern.

Isaac Kohane, MD, PhD, who has also served as a co-author of the Institute of Medicine Report on Precision Medicine, which has served as the template for national efforts, has spent decades exploring how machine learning can advance medicine while preserving the judgment that defines clinical practice. His research emphasizes that artificial intelligence in healthcare must align with the ethical traditions and professional responsibilities of medicine.

“AI systems in medicine must ultimately reflect the values of the profession they serve,” Kohane has written in discussions about AI alignment in biomedical informatics.

This perspective highlights a crucial distinction between technological capability and clinical responsibility. Many AI models entering healthcare environments were originally designed for broader computational tasks rather than the nuanced realities of patient care. Medicine operates within a landscape shaped by uncertainty, empathy, and accountability, and technologies introduced into that environment must reflect those values.

Ensuring that artificial intelligence aligns with the principles guiding health-care delivery, therefore, represents one of the most important scientific and ethical challenges facing the future of health.

The Discipline Required to Make Innovation Matter

The health sector has experienced waves of technological enthusiasm before. Electronic health records promised seamless information exchange, but then introduced administrative burdens on health professionals when implemented without thoughtful workflow design. Data analytics promised unprecedented insight, but sometimes led to fragmentation when systems failed to communicate across institutions.

Artificial intelligence now stands at a similar moment in the evolution of health technology.

Its capabilities in supporting decision-making flow are extraordinary, yet realizing them will require disciplined leadership to evaluate, integrate and govern AI tools within health-care delivery systems. Health leaders must learn to ask deeper questions before embracing the next algorithmic breakthrough. What problem does this system truly solve? How does it strengthen clinical practice? What assumptions guide its recommendations? How does its use advance the mission of improving patient health?

These questions move the conversation beyond technological novelty toward operational practicality. It’s among the many reasons these three global leaders step to the HIMSS stage together.

Artificial intelligence will undoubtedly reshape the health ecosystem in the years ahead. Its long-term impact, however, will not be determined solely by the sophistication of algorithms or the speed of technological progress. Along with how to leverage AI, ChatGPT and LLMs, users require heightened cognitive awareness.

It will be determined by whether the health community develops the discipline and ability required to translate innovation into systems that strengthen care, support clinicians and improve the health of the populations they serve.

The real story of artificial intelligence in health is no longer about what machines can do. It is about how wisely the health sector chooses to use them.

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