CHARLOTTESVILLE — R. Andrew Taylor is vice chair of research and innovation in the Department of Emergency Medicine at the University of Virginia School of Medicine. Arwen B.L. Declan is a clinical assistant professor in Clemson University's School of Health Research. R. Taylor is the corresponding author of the npj Digital Medicine paper outlining the Total Mission Value (TMV) framework.

"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," R. Taylor said. "Typical approaches tend to measure cost, because cost is the easiest thing to measure," he added.

"We built this framework to give organizations a structured way to also weigh what an AI tool does for patients, for staff and for the quality of care," he said. The framework integrates five priorities: patient care, staff experience, hospital operations, economic impact, and education and research. The framework organizes priorities into a pyramid with patient care at the top, ethics as the foundation, and economic sustainability as the base. The TMV framework explicitly integrates ethical foundations such as equity into all five value domains rather than treating them as a standalone consideration.

"Hospitals are seeing a huge number of new AI tools marketed to improve healthcare," Arwen B.L. Declan said. "The challenge is to figure out which ones actually will," she added. "That requires weighing an AI tool's impact across clinical, operational and financial dimensions, while keeping patient care at the center of every decision," Declan said.

"AI tools could enhance care speed, diagnostic accuracy and costs efficiency while supporting population health, scientific inquiry and operational management," he said. "However, they also introduce risks of bias, opacity, workforce displacement and erosion of the patient-clinician relationship that are invisible to cost-focused analyses," she added.

"Our hope is that keeping the mission front and center actually speeds good AI adoption rather than slowing it down, because it builds the trust that patients and clinicians need," he said. "Technology should help us take better care of people," he added. "If we keep that as the goal, the efficiency and the savings tend to follow," he said.

The Total Mission Value framework provides hospital administrators with a structured method to evaluate artificial intelligence tools beyond simple cost metrics. By integrating clinical, operational, and financial dimensions, the framework addresses the rapid influx of AI technologies marketed to healthcare institutions. This approach aims to mitigate risks such as bias and workforce displacement while prioritizing patient care and ethical considerations in adoption decisions.