Data Sheet 1_Operationalizing clinical artificial intelligence through secure FHIR pipelines: a zero-trust cloud reference architecture for EHR interoperability.docx

Applications are consumers, not a sixth layer. An illustrative adult readmission-risk workflow connects identity, policy, source versions, features, model release, scoring, presentation, and human action. Its symbolic FHIR R4 evidence linkage includes explicit R5 translation cautions and policy-aware authorization, including consent where applicable.

Six propositions test incremental value against a well-run contemporary platform without removing its native safeguards; simulated ablations isolate particular links. Independent reference standards, denominators, support, counterevidence, and inconclusive conditions expose operational and human-factors trade-offs. A bounded synthetic-data companion implementation makes selected exchange controls inspectable; it does not implement the complete clinical-AI architecture or validate its propositions.

No empirical architecture evaluation, patient dataset, clinical effectiveness, or independent expert validation is reported. Staged future studies must establish incremental benefit without disproportionate burden or inappropriate reliance.</p>