An auditable and source-verified framework for clinical AI decision support: integrating retrieval-augmented generation with data provenance
Abstract
Artificial intelligence (AI) has shown promise in supporting clinical decision making, yet adoption in healthcare remains limited by concerns regarding transparency, verifiability, and accountability of AI-generated recommendations. In particular, generative and data-driven CDS systems often provide outputs without clearly exposing the evidentiary basis or reasoning process underlying their conclusions. This article presents a conceptual framework for auditable and source-verified AI-based clinical decision support, grounded in principles from evidence-based medicine, data provenance, and trustworthy AI. The proposed architecture integrates a curated medical knowledge base with explicit provenance metadata, a retrieval-augmented reasoning (RAG) engine that links generated recommendations to identifiable clinical guidelines and peer-reviewed sources, and a tamper-evident audit logging mechanism that records system inputs, retrieved evidence, and inference steps for retrospective review. This work does not introduce a new algorithm nor report a prototype implementation; rather, it synthesizes existing technical approaches into a coherent system design intended to improve traceability, clinician trust, and regulatory readiness. Key feasibility challenges are discussed, including knowledge-base governance and updating, citation fidelity in RAG architectures, bias propagation from underlying evidence, latency and usability trade-offs, privacy considerations, and alignment with…
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