Health system legal departments have grown comfortable with generated documentation, which is treated as a transcription aid attested to by the signing clinician. Generated inference — a model's assessment of what is likely going on — is being handled very differently.

The guidance circulating at several systems is to keep model-generated differential diagnoses, risk assessments and recommendations out of the permanent record unless they were acted upon, and to document the clinician's own reasoning separately in either case. The concern is a chart containing a model's suggestion that was correct and not followed.

Clinicians have raised a reasonable objection: a suggestion that influenced the decision and is not documented makes the record less accurate, not more. Several ethicists have made the same argument more forcefully.

No consensus has formed. What has formed is a fairly clear split between institutions that treat model output as a working note and institutions that treat it as part of the record, with the choice driven almost entirely by counsel rather than by clinical or informatics leadership.