The Decentralized AI Ecosystem in Healthcare: A Systematic Review of Technologies, Governance, and Implementation

Abstract

This research examines the emerging ecosystem of models that are developed and run across a distributed network of computers called decentralized artificial intelligence. The focus is to understand these models in the healthcare context and with a focus on their core components: technologies, governance frameworks, and real-world applications. A systematic literature review was conducted, analyzing peer-reviewed studies from PubMed, Scopus, and Web of Science to map the current landscape of the field. The primary objective was to synthesize the current research on decentralized approaches in healthcare, including core approaches like federated learning and blockchain-based AI models, as well as emerging concepts such as agentic AI blockchain-based AI models and DAOs, to comprehend their application in clinical and operational settings. The research assesses the maturity of these implementations, ranging from pilot programs to large-scale organizational settings. It also identified the key computational and technical methods and platforms used and the key benefits and challenges influencing their adoption. The findings underscore the pivotal role of the decentralized paradigm in addressing the fundamental limitations of traditional AI, including data privacy, trust, institutional silos, and regulatory complexity. Insights are also offered for healthcare providers, technology developers, researchers, and policymakers aiming to navigate and leverage decentralized AI to build more equitable, efficient, and collaborative healthcare systems.

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