Artificial intelligence (AI) is transforming healthcare at an unprecedented pace, yet many hospitals lack practical guidance for evaluating new AI tools beyond their financial cost. To address this gap, University of Virginia (UVA) Health emergency medicine physician R. Andrew Taylor, MD, MHS, and Clemson University researcher Arwen B.L. Declan, MD, PhD, have developed the Total Mission Value framework. Their model is designed to help healthcare organizations adopt AI while ensuring that high-quality, patient-centred care remains the primary focus.

The framework is presented in a new paper that argues healthcare organizations should evaluate AI through an ethical lens rather than focusing solely on efficiency or cost savings. Taylor and Declan emphasize that hospitals face increasing pressure to adopt AI quickly, but they need a structured approach that considers how these technologies affect patients, healthcare professionals, and communities.

At the centre of the Total Mission Value framework is a pyramid that places patient care and the patient experience at its highest priority. The model is grounded in ethical principles and supported by economic sustainability, reinforcing the idea that AI should strengthen healthcare delivery by supporting clinicians rather than replacing them or adding unnecessary administrative burdens.

“AI is being adopted in medicine at a scope and velocity we have never seen before, but hospitals haven’t had a good way to weigh these decisions as a whole,” said Taylor, Vice Chair of Research and Innovation in UVA’s Department of Emergency Medicine. He noted that organizations often prioritize cost because it is the easiest factor to measure. In contrast, the new framework encourages hospitals also to evaluate AI’s impact on patients, staff, and quality of care.

While acknowledging AI’s enormous potential to improve diagnostic accuracy, care delivery, operational efficiency, population health, and research, the authors also caution that these technologies present significant risks. AI systems can introduce bias, lack transparency, disrupt the healthcare workforce, and weaken the patient-clinician relationship if implemented without careful evaluation.

To address these challenges, the framework incorporates five ethically grounded priorities: patient care, staff experience, hospital operations, economic impact, and education and research. Patient care remains the highest priority, emphasizing integrity, honesty, trust, compassion, respect, and truly patient-centred care. Staff experience focuses on using AI to strengthen workforce development, teamwork, and interdisciplinary collaboration.

Declan explained that healthcare organizations must resist evaluating AI solely through financial or operational measures. “Hospitals are seeing a huge number of new AI tools marketed to improve healthcare. The challenge is to figure out which ones actually will,” she said. She emphasized that meaningful evaluation requires balancing clinical, operational, and financial outcomes while ensuring patient care remains central to every decision.

Ultimately, Taylor and Declan argue that hospitals must never lose sight of their defining mission: providing exceptional patient care. Taylor hopes the framework will accelerate responsible AI adoption by building trust among clinicians and patients. “Technology should help us take better care of people,” he said. “If we keep that as the goal, the efficiency and the savings tend to follow.”

More information: Arwen BL Declan et al, Integrating mission-aligned value with cost to assess the economic impact of AI in healthcare, npj Digital Medicine. DOI: 10.1038/s41746-026-02892-z

Journal information: npj Digital Medicine Provided by University of Virginia Health System