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AI as an Ecosystem - Ensuring Generative AI Is Safe and Effective
Enrico Coiera1, David Fraile-Navarro1
1Australian Institute for Health Innovation, Macquarie University, Sydney.
NEJM AI
|October 26, 2026
Abstract:
AbstractTraditional scientific methods may not be sufficient to evaluate generative artificial intelligence (GenAI) due to its nondeterministic performance and lack of structural transparency. Viewing GenAI as an ecosystem may facilitate global performance analysis, such as estimating resilience and sustainability as conditions or tasks change. Adopting GenAI necessitates a shift in evaluation focus from reliance on premarket assessment to real-world postmarket surveillance.
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