This study investigates the adoption and effectiveness of AI-based anomaly detection in cross-provider electronic health record (EHR) environments. It aims to (1) identify the organisational and digital capabilities required for successful implementation and (2) evaluate the performance and interpretability of lightweight anomaly detection approaches using contextual audit data. A semi-systematic scoping synthesis is conducted to derive a four-pillar readiness framework covering governance, infrastructure/interoperability, workforce, and AI integration, operationalised as a 10-item checklist with measurable indicators. This is complemented by a simulation of cross-provider audit logs incorporating contextual features such as provider mismatch, time of access, days since discharge, session duration, and access frequency. A rule-based approach is benchmarked against Isolation Forest, with SHAP used to explain model behaviour. Results show that rule-based methods achieve high recall but generate higher alert volumes, while Isolation Forest reduces alert burden at the cost of lower sensitivity. SHAP analysis highlights provider mismatch and off-hours access as dominant anomaly drivers. The study proposes a staged deployment strategy combining rules for coverage and machine learning for prioritisation, supported by explainability and continuous monitoring. The findings contribute a practical readiness framework and empirical insights to guide the implementation of AI-based anomaly detection in multi-provider healthcare environments.
Artificial Intelligence (AI)-based prospective anomaly detection methods are increasingly deployed in high-dimensional and nonlinear settings. Among these approaches, AI-based statistical process monitoring (SPM) is widely used, providing a structured framework for prospective monitoring. Once an anomaly is detected, a diagnosis method is needed to identify the features driving the flagged observation away from normal behaviour. Traditional SPM diagnosis methods are typically designed for specific detection models and cannot be directly applied to AI-based methods. Model-agnostic explainable AI (XAI) offers a general framework for feature relevance explanation. However, existing methods suffer from scalability limitations or assign relevance to noise features, reducing diagnosis accuracy. We propose a scalable, baseline-referenced diagnosis method that uses both the anomalous observation and normal baseline information. We provide mathematical guarantees that under a mean-shift anomaly setting, the proposed method achieves higher faithfulness in detecting the features causing the anomaly compared to LIME. Simulation studies and a real-world case study validate the effectiveness of the proposed method and show that it generates more faithful and accurate diagnosis results for AI-based prospective anomaly detection methods.
Jiaqi Qiu, Rob Goedhart, Jannis Kurtz +1
Department of Business Analytics, Amsterdam Business School, University of Amsterdam, Amsterdam, The Netherlands
The banking sector increasingly relies on automated systems to monitor electronic transactions for signs of fraud, yet conventional rule-based approaches struggle with high false-positive rates and offer no justification for their outputs, limiting their utility for compliance teams. This paper introduces an Explainable Artificial Intelligence (XAI) framework tailored for banking transaction anomaly detection within internal audit workflows. An Isolation Forest (iForest) model performs unsupervised anomaly scoring, while a SHAP (SHapley Additive exPlanations) layer provides transaction-level, feature-attributed explanations grounded in cooperative game theory [8]. A lightweight Streamlit dashboard renders these outputs in a form accessible to audit professionals without machine learning expertise. Evaluation on a synthetic banking dataset yields 0.91 precision and 0.88 recall, outperforming three unsupervised baselines. Expert feedback confirms that feature-level explanations measurably improve auditor confidence and decision quality. The framework advances the practical deployment of accountable, transparent AI in regulated financial environments.
Anupa Lodhi
Department of Computer Science and Engineering · SAGE University Indore, India
We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates.
Milos Hauskrecht, Michal Valko, Shyam Visweswaran +3
Computer Science Department · Department of Biomedical Informatics · Department of Critical Care Medicine