Healthcare Architecture & AI-Governance Readiness Checklist

You can name the part of your architecture that breaks first under 10× the current load.

A new engineer can trace a request end-to-end from a single up-to-date diagram.

You know which decisions are reversible and which ones you are now stuck with.

You can ship a change to one area without a manual regression sweep of everything else.

You can point to exactly where PHI lives, who can read it, and how access is logged.

Every third-party service that touches PHI is covered by a signed BAA.

PHI is encrypted in transit and at rest, and you can prove it, not just assert it.

You have a written, rehearsed answer for "what happens in the first 24 hours of a breach."

You have a deliberate position on HL7 / FHIR rather than a one-off integration per partner.

Adding a new EHR, lab, or payer integration is estimable, not open-ended.

You own a mapping of your data model to the standards your partners expect.

A partner integration failing in production has an owner and an alert, not a support ticket.

You know whether PHI ever reaches a model prompt, and on whose infrastructure it runs.

AI-assisted decisions that affect patients have a human-in-the-loop checkpoint by design.

You can reconstruct why a given AI output was produced — inputs, version, and provenance.

You have a written line between what AI may decide and what it may only suggest.

No single person is the only one who can deploy, debug, or explain a critical system.

You have a release cadence and a rollback path you have actually used.

Engineering priorities trace to the business, not just to whoever asked most recently.

You can onboard a senior engineer to first meaningful commit in days, not weeks.