Evaluating Fiscal Credibility Through the Lens of Durability: Value Decay in AI‐Enabled Clinical Documentation
Samuel Atiku, Olufisayo OlakotanABSTRACT
Rationale, Aims, and Objectives
AI‐enabled clinical documentation tools are deployed to mitigate workforce burnout, yet technical efficiency observed in short‐term evaluations frequently fails to translate into sustained institutional value. This study evaluates the fiscal credibility of these tools through the lens of durability, investigating how their value is sustained, eroded, or transformed once routine implementation is established.
Methodology
We employed a netnographic design to analyse professional discourse across seven healthcare subreddits. Using a custom harvesting protocol over a 24‐month window (2024–2025), we screened 2645 text segments. A “Double‐Lock” filtration system isolated 39 high‐fidelity discursive incidents focusing on post‐implementation sustainment. Data were analysed using Reflexive Thematic Analysis informed by an abductive logic.
Results
Analysis reveals that durability failure is driven by three socio‐organisational mechanisms of value decay rather than technical inadequacy. First, Incentive Conversion occurs when administrative actors capture efficiency gains to increase throughput via a Jevons Paradox effect, transforming workforce relief into labour intensification. Second, Maintenance Entropy creates a hidden maintenance debt through the gradual accumulation of unpriced articulation work. Third, Legitimacy Collapse occurs when the cognitive load of verification exceeds the clinician's bandwidth, leading to the rejection of the tool's epistemic authority.
Conclusion
AI documentation tools risk becoming “zombie technologies”, operationally active but fiscally hollow, because institutional extraction mechanisms cannibalise their intended value. Achieving true durability requires contractually ring‐fencing efficiency dividends for workforce recovery and explicitly pricing the shadow labour of maintenance and human‐in‐the‐loop verification. Because fiscal and ethical judgements may conflict, we recommend that their oversight operate as separate and independent functions. These findings have direct implications for health systems reform, particularly procurement governance, productivity policy, and workforce sustainability strategies for digital health.