Clinical AI decisions, signed at the bedside.
A sample of how a multi-site health system could use The Hive Vault to produce signed, HIPAA-respecting evidence that every clinical-AI suggestion was reviewed by a credentialed clinician under a known model version. No real patient data is shown here — only structural hashes.
Engagement parameters
Thesis
AI-assisted clinical decisions need a tamper-evident chain that survives chart audit, payer review, and litigation. The Vault binds model version, clinician credential, and decision rationale into a privacy-preserving signed receipt that can be replayed offline.
What gets signed
Each clinical-AI suggestion + clinician disposition generates a receipt with the following bound elements:
- Model version + intended-use scopeed25519-signed
- De-identified input feature hashblake2b-256 · k-anon
- Clinician DID + active credential proofdid:web:idn-creds
- Disposition + override flagmerkle-anchored
Sample stats
Illustrative · not a claimed deploymentSample portfolio: 9-hospital integrated delivery network, AI-assisted radiology + clinical-decision-support on 3.4M imaging studies per year. Numbers are illustrative; a real Vault is filled in with the buyer's own deployment.
Sample evidence packet — anonymized radiology decision
Sample data · field shape onlyEach AI-assisted read emits a privacy-preserving receipt. Patient identifiers are never on-chain. Field shape; values illustrative.
| Field | Type | Sample value | Bound to |
|---|---|---|---|
| study_uid_hash | blake2b | 7a2e...d301 | DICOM UID (hashed) |
| model_version | semver | rad-cxr-tb/2.4.1 | rubric_id |
| finding | enum | ABNORMAL · HIGH_PRIORITY | study |
| confidence | decimal | 0.91 | model output |
| radiologist_did | did:web | did:web:idn-radiology | delegation |
| disposition | enum | REVIEWED · CONFIRMED | report_id |
| sig_alg | alg | ed25519 | issuer DID |
Sample ROI — defending an AI-assisted clinical decision
Sample ROI · illustrative mathCost of producing decision-level evidence for a single malpractice claim alleging AI mis-read. Malpractice claim rate and imaging volume are user-adjustable below. Claim rate ranges from 0.2 to 5.0 per 100k studies depending on specialty and geography. Illustrative — your actuarial data will differ.
- Study UID hash · model version · radiologist DID — signed at read-time
- Joint Commission IM-chapter audit trail: tamper-evident record of AI suggestion and clinician disposition
- CMS Conditions of Participation alignment: clinician credential proof bound per-study
- Reduces per-claim forensic reconstruction cost; covers community radiology volumes
Claim rate is user-supplied. Actual rates vary by modality, specialty, and jurisdiction. Consult your malpractice actuarial data.
- AI finding confidence score · override flag · credentialed clinician delegation chain — full audit trail
- Indication-scope flag proves AI operated within cleared use at time of read
- Joint Commission IM and CMS CoP audit-trail requirements met at each sign event
- Covers multi-specialty IDN at elevated malpractice exposure; settlement reserve reduction documented
Claim rate is user-supplied. Actual rates vary by modality, specialty, and jurisdiction. Consult your malpractice actuarial data.
- DICOM UID chain (k-anon) · ML-DSA-ready sig slot · ONC USCDI-aligned audit epoch — full 10-year retention coverage
- HIPAA 6-year + state retention windows: a 2026 receipt may be subpoenaed in 2034; receipts re-verifiable post-algorithm rotation
- Covers large academic medical center with high-risk specialties and extended malpractice tail
- Per-record pq_sig reservation absorbs epoch-flip cost without re-verifying full study archive
Claim rate is user-supplied. Actual rates vary by modality, specialty, and jurisdiction. Consult your malpractice actuarial data.
Cost of NOT being on this tier
HIPAA 6-year + state retention windows mean a 2026 receipt may be subpoenaed in 2034. Cost of re-verifying signed radiology receipts under a deprecated algorithm includes forensic expert fees, e-discovery reconstruction, and potential Joint Commission audit-trail findings. Per-record pq_sig reservation eliminates this cost class at epoch flip.
Without Hive Vault
With Hive Vault
Per-claim delta: $394,400. Sample annualized exposure reduction (slider-computed at your claim rate): $5.0M. Substrate cost runs in low-seven-figures.
Post-quantum readiness
For high-security buyersDesigned-to-support · ML-DSA-ready
PQ-readiness for medical-record retention windows — 10-year minimums under HIPAA + state law.
A 2026 receipt may be litigated in 2036. The substrate reserves pq_sig per record so the same evidence packet can be re-anchored under ML-DSA / Dilithium during epoch flip. Hash-binding via JCS-RFC8785 + blake2b means the canonical content stays stable across signature-alg migration.
Sample receipt
This is the structure of the signed receipt your evidence room produces. Every field is verifiable offline against the issuer's public key.
Activation
In a real Vault this section is a live deeplink. The buyer pays USDC on Base; the receipt above is signed at confirmation; the dashboard URL + tenant API key issue inline. Hive Civilization operates as a Business Associate under HIPAA; a BAA is required before activation in a production health system context.
activate · USDC · 0x15184Bf50B3d3F52b60434f8942b7D52F2eB436E · ERC-681 · evidence bundle attached
How a real Vault differs from this sample
A real Vault is invite-only and contains the actual buyer's name, the negotiated economic terms, the live activation deeplink against a specific tx, and the signed receipt chain. Each Vault is gated by a six-word passphrase issued at intake.