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The right evaluation depends on the intended use, patient population, clinical workflow, and consequences of error. A model that performs well on one dataset is not automatically ready to guide care.

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• Define context of use and responsibility.
• Evaluate representative patients, devices, and workflows.
• Treat regulatory status and model performance as specific evidence.

Define the clinical or operational purpose before choosing a model. A system that prioritizes records, suggests a finding, and makes a treatment recommendation have different risk profiles and evidence requirements. Identify who reviews the output, what information they see, and what happens when the system is unavailable or uncertain. Use representative data and preserve the distinction between development, validation, and real-world evaluation. Check subgroup performance, missing data, device differences, and changes in clinical practice. A retrospective result can support investigation while still falling short of evidence for prospective use. Document the model, data, version, and context of use. FDA’s AI-enabled device list emphasizes the relationship between a device’s intended use, technology, and applicable review. Regulatory status is specific to the authorized device and use; it is not a general endorsement of every model or workflow. Protect health information across inputs, logs, derived features, and outputs. Keep a qualified human decision-maker responsible for consequential care and provide a route to investigate and correct errors.

1. Imagine a model ranking 100 emergency records for review and a second system suggesting a diagnosis.
2. Measure whether the first ranking helps clinicians find urgent cases; do not treat that result as evidence for the second system’s diagnosis.
3. Test missed cases, review time, and escalation procedures before using either output in practice.

This constructed example shows why healthcare evidence must match the precise intended use.