{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:49:13Z","timestamp":1792259353848,"version":"4.4.0"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Healthc Manage Forum"],"abstract":"<jats:p>Clinical Artificial Intelligence (AI) tools are frequently developed in academic centres yet deployed in community hospitals with different workflows, staffing, and oversight. In Canada, where community hospitals constitute approximately 90% of hospitals, this creates a validation-to-implementation gap. Health Canada\u2019s 2026 pre-market guidance for machine learning-enabled medical devices addresses manufacturer responsibilities but leaves hospital implementation responsibilities under-specified. This article proposes a framework for community hospital AI implementation readiness organized around four dimensions (contextual validity, sociotechnical workflow integration, calibrated human-AI reliance, and adaptive safety, equity, and governance), operationalized through simulation-based systems testing. The framework specifies what a community hospital must build to deploy a specific AI tool safely, extending an established Canadian tradition of simulation-based systems testing to the lifecycle risks of AI. A real Canadian deployment, the CHARTwatch early warning system, illustrates the dimensions in practice. Safe AI deployment in community hospitals is an institutional capacity, not a procurement decision. Leaders should treat implementation readiness as core infrastructure investment.<\/jats:p>","DOI":"10.1177\/08404704261494446","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:12:14Z","timestamp":1792102334000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical AI in Canadian Community Hospitals: A Framework for Implementation Readiness"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7533-3939","authenticated-orcid":false,"given":"Changiz","family":"Mohiyeddini","sequence":"first","affiliation":[{"name":"Michael Garron Hospital"},{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2104626"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081554"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.13685"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-024-02873-4"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-024-01243-2"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-024-02883-2"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/08404704251345312"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.54745"},{"key":"e_1_3_6_10_2","volume-title":"Pre-Market Guidance for Machine Learning-Enabled Medical Devices","author":"Health Canada","year":"2026","unstructured":"Health Canada. Pre-Market Guidance for Machine Learning-Enabled Medical Devices. Government of Canada; 2026. https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/medical-devices\/application-information\/guidance-documents\/pre-market-guidance-machine-learning-enabled-medical-devices.html. Accessed August 31, 2026."},{"key":"e_1_3_6_11_2","volume-title":"Guidance on Terms and Conditions for Class II to IV Medical Devices","author":"Health Canada","year":"2026","unstructured":"Health Canada. Guidance on Terms and Conditions for Class II to IV Medical Devices. Government of Canada; 2026. https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/medical-devices\/application-information\/guidance-documents\/terms-conditions-class-ii-iv.html. Accessed August 31, 2026."},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8775"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/00140139.2013.838643"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-070904"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41077-019-0108-7"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41077-020-00138-w"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.240132"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-026-02679-2"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01909-3"}],"container-title":["Healthcare Management Forum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08404704261494446","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08404704261494446","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08404704261494446","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:18:21Z","timestamp":1792257501000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08404704261494446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":18,"alternative-id":["10.1177\/08404704261494446"],"URL":"https:\/\/doi.org\/10.1177\/08404704261494446","relation":{},"ISSN":["0840-4704","2352-3883"],"issn-type":[{"value":"0840-4704","type":"print"},{"value":"2352-3883","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"article-number":"08404704261494446"}}