Bedside AI permit-before-finalization gate and safety receipt rail for clinical edge inference
Systems and methods govern bedside AI inference output finalization on a clinical device. A permit rail intercepts an inference request or a user-interface finalization request for an inference episode, obtains an attested device-state vector, a clinical context envelope, and a clinician identity token, and evaluates a policy graph to compute a permit outcome as a permit value or a non-permit value. A user-interface finalization gate at a commit boundary prevents finalization unless the permit outcome corresponds to the permit value; in certain embodiments, an override indicator or attestation satisfying policy is received and incorporated into policy evaluation. For each episode, the device generates a structured bedside safety receipt encoding the device-state vector, clinical context envelope, clinician identity token, policy identifier and version/digest/epoch information, the permit outcome, and an output summary or digest, and may include finalization provenance and integrity protection, including a digital signature or tamper-evident anchoring commitment.
1 . A bedside clinical device comprising one or more processors and memory storing instructions that, when executed by the one or more processors, cause the bedside clinical device to:
(a) host or access an AI inference engine configured to generate an AI inference output for a bedside inference episode;
(b) receive or intercept, by a bedside AI permit rail, at least one of: (i) an inference request or (ii) a user-interface finalization request associated with the bedside inference episode;
(c) obtain an attested device-state vector for the bedside clinical device, the attested device-state vector comprising one or more indicators including at least one indicator selected from: a power or energy state indicator, a temperature indicator, or a software or firmware integrity indicator of the bedside clinical device;
(d) obtain a clinical context envelope for the bedside inference episode, the clinical context envelope comprising (i) one or more identifiers of at least a clinical episode, encounter, or order and (ii) a care location;
(e) obtain a clinician identity token indicating an authenticated clinician and at least one role or privilege attribute associated with the bedside inference episode;
(f) evaluate, by a policy evaluator, a policy graph based at least on the attested device-state vector, the clinical context envelope, and the clinician identity token to compute a permit outcome selected from a plurality of enumerated outcomes comprising at least a permit value and a non-permit value;
(g) enforce a permit-before-finalization configuration by controlling a user interface of the bedside clinical device at a user-interface finalization gate corresponding to a commit boundary at which the AI inference output becomes user-visible or clinically actionable, such that the AI inference output is prevented from being finalized to the user interface for the bedside inference episode unless the permit outcome corresponds to the permit value among the enumerated outcomes;
(h) generate, for the bedside inference episode, a structured bedside safety receipt encoding at least the attested device-state vector, the clinical context envelope, the clinician identity token, a policy identifier and at least one of a policy_version identifier, a policy digest, or a policy epoch associated with the policy graph, the permit outcome, and a summary or digest of the AI inference output.
2 . The bedside clinical device of claim 1 , wherein the plurality of enumerated outcomes further comprises REQUIRE_OVERRIDE, HOLD, and DENY, wherein REQUIRE_OVERRIDE denotes that an explicit override indicator or attestation satisfying policy is required prior to finalization, and wherein enforcing the permit-before-finalization configuration comprises, responsive to the permit outcome corresponding to REQUIRE_OVERRIDE, withholding finalization absent the override indicator or attestation and, responsive to receiving the override indicator or attestation, permitting finalization by causing the policy evaluator to evaluate the policy graph with the override indicator or attestation as at least one of an additional input or an additional condition, thereby causing the policy evaluator to produce a permit outcome corresponding to the permit value for purposes of the user-interface finalization gate.
3 . The bedside clinical device of claim 1 , wherein the clinical context envelope further comprises at least one of: (i) a hashed or pseudonymized patient identifier; (ii) a modality identifier; or (iii) a timestamp or sequence identifier for the bedside inference episode.
4 . The bedside clinical device of claim 1 , wherein the policy graph encodes a condition that, when the attested device-state vector indicates that a power or temperature threshold is exceeded, causes the permit outcome to correspond to the non-permit value and thereby prevents finalization.
5 . The bedside clinical device of claim 1 , wherein enforcing the permit-before-finalization configuration further comprises: (i) in response to the permit outcome corresponding to the non-permit value, causing the user interface to render a safe-mode overlay in place of an AI output region; and (ii) optionally allowing one or more non-AI device functions of the bedside clinical device to remain available.
6 . The bedside clinical device of claim 1 , wherein the plurality of enumerated outcomes further comprises a PERMIT_WITH_GUARDRAILS outcome that is a permit value, and wherein enforcing the permit-before-finalization configuration further comprises, when the permit outcome corresponds to the PERMIT_WITH_GUARDRAILS outcome, allowing finalization subject to at least one guardrail comprising suppressing at least one type of predicted value, risk score, or recommendation from being displayed or committed.
7 . The bedside clinical device of claim 1 , wherein generating the structured bedside safety receipt further comprises constructing a clinician response field indicating at least one of acceptance, override, or ignoring, and populating the clinician response field based on clinician actions captured via the user interface.
8 . The bedside clinical device of claim 1 , wherein generating the structured bedside safety receipt further comprises digitally signing the bedside safety receipt using a device key and anchoring at least a hash or commitment of the bedside safety receipt to an external tamper-evident store.
9 . The bedside clinical device of claim 1 , wherein the structured bedside safety receipt further encodes at least one of a finalization_gate_id or a ui_commit_scope identifier corresponding to the user-interface finalization gate at which finalization was allowed or prevented.
10 . The bedside clinical device of claim 1 , wherein obtaining the attested device-state vector further comprises verifying a remote attestation report from a trusted execution environment hosting the AI inference engine, and forcing the permit outcome to correspond to the non-permit value in response to a failure of the remote attestation report.
11 . The bedside clinical device of claim 1 , wherein the user-interface finalization gate comprises at least one of a display composition_layer, a display driver commit hook, a framebuffer commit boundary, a privileged user-interface service gateway, or an equivalent commit boundary at which output becomes user-visible or clinically actionable.
12 . A computer-implemented method of governing bedside AI output finalization on a bedside clinical device, the method comprising:
(a) receiving, by a bedside AI permit rail executing on or adjacent to the bedside clinical device, at least one of an inference request or a user-interface finalization request for a bedside inference episode;
(b) obtaining, for the bedside clinical device, an attested device-state vector;
(c) obtaining, for the bedside inference episode, a clinical context envelope;
(d) obtaining a clinician identity token;
(e) evaluating a policy graph based at least on the attested device-state vector, the clinical context envelope, and the clinician identity token to compute a permit outcome selected from enumerated outcomes comprising at least a permit value and a non-permit value;
(f) enforcing a permit-before-finalization configuration by controlling a user interface at a user-interface finalization gate such that an AI inference output is prevented from being finalized to the user interface unless the permit outcome corresponds to the permit value; and
(g) generating a structured bedside safety receipt encoding at least the attested device-state vector, the clinical context envelope, the clinician identity token, a policy identifier and at least one of a policy_version identifier, a policy digest, or a policy epoch associated with the policy graph, the permit outcome, and a summary or digest of the AI inference output.
13 . The method of claim 12 , wherein obtaining the attested device-state vector comprises sampling at least a battery state-of-charge indicator, a power source indicator, and a device temperature indicator.
14 . The method of claim 12 , further comprising rendering a safe-mode overlay in place of the AI inference output when the permit outcome corresponds to the non-permit value.
15 . The method of claim 12 , wherein the enumerated outcomes further comprise a PERMIT_WITH_GUARDRAILS outcome that is a permit value, and wherein allowing finalization when the permit outcome corresponds to the PERMIT_WITH_GUARDRAILS outcome comprises suppressing at least one type of predicted value, risk score, or recommendation from being finalized to the user interface or stored.
16 . The method of claim 12 , wherein generating the structured bedside safety receipt further comprises capturing clinician actions and encoding a clinician response field.
17 . The method of claim 12 , further comprising digitally signing the structured bedside safety receipt and transmitting at least a hash or commitment of the structured bedside safety receipt to a tamper-evident store.
18 . The method of claim 12 , wherein generating the structured bedside safety receipt further comprises encoding at least one of a finalization_gate_id or a ui_commit_scope identifier corresponding to the user-interface finalization gate at which finalization was allowed or prevented.
19 . A non-transitory computer-readable medium storing instructions that, when executed by one or more processors of a bedside clinical device, cause the bedside clinical device to perform the method of claim 12 .
20 . The non-transitory computer-readable medium of claim 19 , wherein the instructions further cause the bedside clinical device to enforce the permit-before-finalization configuration at the user-interface finalization gate by preventing user-visible finalization of the AI inference output absent the permit outcome corresponding to the permit value.