Selected decision moments and governance adjustments across the three CAR cycles
| CAR cycle | Decision episode | Nature of disagreement | Decision authority | Governance adjustment |
|---|---|---|---|---|
| Cycle 1 | Adoption of reference dataset (diabetology) | Cross-specialty comparability and variable definitions | Clinical leads (after interdisciplinary debate) | Provisional shared CDM; formalized harmonization protocol |
| Cycle 2 | Introduction of synthetic data under FL | Clinical plausibility and regulatory legitimacy | Technical proposal with formal clinical approval | TSTR separation; unified real test set; retraining schedule |
| Cycle 3 | Institutionalization of clinical explanation rounds | Sufficiency of statistical metrics and SHAP explanations for accountable action | Clinical validation authority | Formalized explanation rounds; retraining triggers; documented review process |
| Decision episode | Nature of disagreement | Decision authority | Governance adjustment | |
|---|---|---|---|---|
| Cycle 1 | Adoption of reference dataset (diabetology) | Cross-specialty comparability and variable definitions | Clinical leads (after interdisciplinary debate) | Provisional shared CDM; formalized harmonization protocol |
| Cycle 2 | Introduction of synthetic data under | Clinical plausibility and regulatory legitimacy | Technical proposal with formal clinical approval | |
| Cycle 3 | Institutionalization of clinical explanation rounds | Sufficiency of statistical metrics and | Clinical validation authority | Formalized explanation rounds; retraining triggers; documented review process |
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