The story is one most institutional buyers
already know.
A cyclone sweeps Dorothy and her dog Toto
from Kansas to the land of Oz.
The only way home is to find the Wizard.
The Wizard lives in the Emerald City
at the end of the Yellow Brick Road.
Along the way Dorothy meets
three companions.
A Scarecrow who wants a brain.
A Tin Man who wants a heart.
A Cowardly Lion who wants courage.
They walk together,
each believing the Wizard has
what they lack.
They defeat the Wicked Witch of the West.
They reach the Emerald City.
They stand before the great
and powerful Wizard
who has answers for everyone.
Then Toto pulls back the curtain.
The Wizard is a small ordinary man
pulling levers behind a screen,
projecting a voice that was never his.
The Scarecrow, the Tin Man, and the Lion
realize they had what they wanted
all along.
The brain. The heart. The courage.
The Wizard only gave them permission
to see it.
Glinda tells Dorothy she always had
the power.
The ruby slippers were on her feet
the whole time.
She clicks her heels three times.
She wakes up in Kansas.
Now decode it.
Dorothy is your institution.
Swept up by the cyclone of clinical AI
deployment, walking a road nobody mapped,
looking for an authority
who can send her home
with a clean audit trail.
The Yellow Brick Road is the clinical AI
deployment journey.
Every health system is walking it
right now.
Most are walking toward the same
Emerald City.
Most assume the Wizard has the answers.
The Scarecrow, the Tin Man,
and the Lion are your CMO,
your CMIO, and your General Counsel.
Each one walking toward the Wizard
believing the Wizard has the brain,
the heart, and the courage
their institution lacks.
HIMSS published the number
behind this assumption.
78 percent of health systems plan
to deploy clinical AI in 24 months.
23 percent have a formal AI
governance structure.
The Wizard is your clinical AI deployment.
The booming voice.
The smoke.
The projection of authority.
The committee meeting where everyone
agrees the model is good enough.
The vendor demo where the recommendation
looks decisive.
The curtain is your governance framework.
Drawn around the deployment.
Hiding what is actually behind it.
The man behind the curtain is the absence
of a named Decision Owner.
The person who decides, documents,
and defends the clinical AI recommendation
at the point of care.
No one is running the levers
with that authority.
The voice the institution hears
is the model.
The Decision Owner seat is empty.
Toto is the audit.
The regulator. The lawsuit.
The named owner question
that eventually pulls back the curtain.
Black Book Research published the number
behind this position.
78 percent of hospital leaders cannot
deliver a complete auditable AI
explanation within 30 days.
The ruby slippers are the Governance Owner
authority your institution already holds.
The CMO who holds the structural power
to commission the accountability
infrastructure.
The CMIO who holds the operational
authority to assign the clinical AI
governance seat.
The General Counsel who holds the legal
standing to cover the deployment.
The right to name the Decision Owner.
The authority to build the room.
The power to close the gap.
Present the whole time.
Never used.
The Wizard was never real.
Both seats were always yours.
Two reveals carry the teaching.
The first reveal exposes what was never
behind the projection.
When the audit pulls back the curtain,
the answer has to be a person.
A named Decision Owner whose seat carries
the authority to decide, document,
and defend the clinical AI recommendation.
Models cannot hold that authority.
Vendors cannot. Committees cannot.
Frameworks cannot.
When no such person has been named,
the institution discovers what was
running the workflow.
Nothing.
The second reveal exposes what was
always there.
The Governance Owner authority
already lives inside the institution.
The CMO holds it.
The CMIO holds it.
The General Counsel holds it.
The authority to name the Decision Owner
exists.
The assignment has not been made.
For every clinical AI deployment
currently live in your institution,
pulling back the curtain today
should surface a name.
A named Decision Owner
whose seat is documented,
whose authority is assigned,
and whose Governance Owner
has formally commissioned the role.
If pulling back the curtain surfaces
a function instead of a name,
the Decision Owner seat is empty.
If the Governance Owner has not
commissioned the role,
the ruby slippers are still
on the floor.
Click them.
MedicoVigilance™ is published every two weeks by Mo Johnson, MD MBA, founder of GPe Research. Each issue teaches one piece of the clinical AI accountability discipline your institution needs before the next deployment decision.
Forward this to a colleague whose institution is still looking for a Wizard.