The Ethics of Leveraging Routinely Collected Patient Data for AI Development: Mixed Methods Study

Responsible AI development requires explicit attention to how EHR data are produced, interpreted, and governed in practice, recognizing that data quality and meaning are shaped by the clinical, institutional, and social contexts in which they originate. Technical solutions or top-down regulation alone are insufficient. Instead, stakeholder-led and context-sensitive approaches are needed to define the purposes, risks, and benefits of medical AI. Grounded in the realities of health care practice and in the perspectives of patients, clinicians, and data custodians, these approaches can strengthen transparency, fairness, and clinical relevance, ensuring that EHR data are used ethically and effectively to support equitable and trustworthy AI innovation.