Artificial intelligence is rapidly becoming embedded in hospital operations, with growing adoption across clinical and operational workflows. One category accelerating this shift is ambient AI. Ambient listening for clinical note-taking has already taken off, and new applications are emerging, including ambient video (computer vision) that observes and interprets clinical workflows. As these systems begin to influence day-to-day operations at scale, the quality of the underlying AI matters more than ever.
This is especially evident in the operating room. Consider an AI system used to predict when a case will end or when a room will be ready. If the technology inconsistently detects when the patient is wheeled out, rooms sit idle longer, PACU isn’t prepared, turnovers start late, downstream cases are delayed, and trust erodes in the solution you’ve painstakingly rolled out.
In other words, in high-stakes hospital environments, not all ambient AI systems are created equal.
AI is no longer the differentiator. Quality is.
Today, many AI solutions look similar on the surface. They use the same terminology or promise similar outcomes. But beneath that surface, model quality can vary significantly. Two AI systems may appear identical during a demo and perform very differently in real-world deployment.
Without clear signals of quality, the only way to differentiate solutions is through resource-intensive pilots, where limitations surface late and only a small fraction make it to scaled deployment.
The evaluation bar must move beyond features to a more fundamental question: does this AI produce decision-grade data that can be trusted at scale? Answering this requires asking vendors tougher questions about how their AI is built, validated, and proven.
What to ask when evaluating AI vendors
1. Ask what data the models were trained on.
AI models are only as reliable as the data behind them. If models are trained exclusively on EHR-derived data, they are learning from manually-entered timestamps that are often incomplete, inconsistently recorded, and biased, which means they may reproduce those same inaccuracies at scale. If vendors use directly observed data, such as sensors or computer vision, ask:
- What quality assurance processes were applied?
- Is there a process to audit or review source data quality?
- Is synthetic data or automatically labeled data used?
- Were models trained across diverse hospital environments?
Some vendors cut corners in training and validation. Without clear evidence of rigor, it is difficult to trust that performance will generalize across organizations.
Learn how Apella is associated with measurable case volume increases across hospitals.
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2. Ask for the right technology performance metrics.
Validate model performance using industry-standard metrics. The F1 score is widely regarded as the gold standard for AI classification models because it balances precision (avoiding false signals) and recall (detecting true events consistently). In healthcare, where outputs inform clinical and operational decisions, the performance bar should be high:
- F1 ≥ 0.98: Necessary for real-time decision-making for individual cases
- F1 0.95–0.97: Generally appropriate for operational decision-making
- F1 0.90–0.94: Acceptable for higher-level aggregate analysis
- F1 < 0.90: Not recommended for production deployment
In practical terms, an F1 of only 0.90 can mean inaccurate data in 1 out of every 10 cases — a level of error that would quickly erode trust.
3. Look for peer-reviewed or external validation.
Vendors willing to publicly report on model performance demonstrate greater rigor than those relying solely on internal validation. Peer-reviewed research requires disclosure of methodology, performance metrics, and limitations, subjecting claims to independent scrutiny. Ask:
- Has model performance been published or independently reviewed?
- Or is proof limited to website claims and internal case studies?
Transparency through public reporting signals maturity and confidence.
4. Demand evidence at scale.
Limited pilots and deployments do not equal enterprise readiness. Ask:
- How many cases has their model been evaluated on?
- Across how many operating rooms and health systems?
- Over what time period?
Performance demonstrated across hundreds of thousands of real-world cases is materially different from results shown from a handful of environments. Enterprise-ready AI should prove it can withstand real-world variability.
5. Evaluate transparency around limitations.
No AI model is perfect. Mature vendors are transparent about where performance is strongest, where it is challenged, and how it is monitored over time. Ask:
- Where does the model struggle?
- How is performance monitored?
- How are edge cases identified and addressed?
Overconfident claims with no discussion of limitations should raise concern.
What decision-grade ambient AI looks like in practice
As ambient AI becomes embedded in hospital infrastructure, knowing how to evaluate quality is no longer optional. It is fundamental to selecting the right solution.
In our next post, we'll examine what decision-grade ambient AI looks like in practice and how transparent, peer-reviewed validation at scale brings these evaluation standards to life.
Learn how Apella is associated with measurable case volume increases across hospitals.
Read the full analysis