Prototype · Governance Infrastructure

European Clinical
Governance Infrastructure
for Cross-Border Care

Structured comparability, risk-adjusted fairness, and supervised transparency — designed for the evolving European healthcare corridor.

Buiten.ai Governance Infrastructure Layer
buitenarts
GP Referral
Gatekeeper continuity
buitenscore
Hospital
Compliance dashboard
buitenclaims
Insurer
Claims governance
ALIGNMENT
VARIANCE
DIVERGENCE
§ Institutional Definition

What Buiten.ai
is — and is not.

This infrastructure is defined as much by its boundaries as by its purpose. Clarity is governance.

Three Pillars of
Structured Comparability

Each pillar addresses a distinct systemic failure in cross-border healthcare — together forming an integrated governance architecture.

01 —

Clinical Comparability

The Indication Matrix structures clinical equivalence across divergent national thresholds — without imposing protocols or overriding physician judgment. Divergence is measured, not judged.

Explore the Matrix →
02 —

Financial Predictability

The Insurance Sustainability Framework transforms volatile cross-border claims into structured, risk-adjusted signals — reducing reserve uncertainty, shortening review cycles, and stabilizing actuarial forecasting.

Insurance Interface →
03 —

Institutional Transparency

Participating hospitals gain structured internal visibility through the compliance dashboard — enabling learning, not exposure. Complexity is contextualized, never penalized. Autonomy remains intact.

Hospital Dashboard →

Role-Separated
Access Portals

Three operationally distinct interfaces — each purpose-bound, role-restricted, and governed by the shared infrastructure architecture.

buitenarts.com
For General Practitioners

Clinical Referral Interface

Preserve gatekeeper continuity across borders. Initiate structured, privacy-preserving referrals with encrypted token generation — no personal identifiers transmitted.

  • Minimum dataset capture protocol
  • Encrypted referral token generation
  • Identity-data architectural separation
  • Secure report return to originating GP
Access Interface →
buitenscore.com
For Hospitals & Clinical Institutions

Institutional Compliance Dashboard

Internal governance visibility for structured alignment. Understand how your escalation thresholds compare — without public exposure, without loss of autonomy.

  • Indication Alignment Indicators
  • Risk-adjusted complication context
  • Longitudinal variance trend analysis
  • Academic recalibration pathway access
Access Dashboard →
buitenclaims.com
For Insurers & Review Teams

Claims Governance Engine

Structure your cross-border review process. Signal-based variance detection enables proportional audit allocation — focus resources where genuine divergence occurs.

  • Structured alignment & variance signals
  • Coding reliability indicators
  • Complication context analysis
  • Financial concordance alerts
Access Engine →

Governance Signals

AI produces structured, explainable signals. No automated decisions. Every output includes trigger parameter, reference threshold, divergence metric, and risk-adjustment modifier.

Signal Green

Alignment

Clinical escalation falls within structured reference thresholds. Documentation complete. Conservative pathway confirmed.

Signal Yellow

Contextual Variance

Divergence detected. Contextual review recommended. Risk-adjustment modifiers applied before signal generation.

Signal Red

Significant Divergence

Structural divergence exceeds reference threshold. Prioritized human review required. No automated consequence.

The Indication
Matrix

The clinical backbone of the infrastructure. Each procedural cluster is decomposed into measurable decision nodes — compared across systems to quantify structural divergence without declaring error.

The matrix evolves through continuous academic recalibration. It is a living governance instrument, not a fixed protocol.

TDI — Threshold Divergence Index
Proportional deviation from structured reference threshold
High divergence triggers transparency and review recommendation — not automatic sanction. Ambiguity increases oversight intensity, never presumption of misconduct.
// Example: Lumbar Disc Herniation — NL–TR Corridor
Decision Node NL Reference TR Kayseri Mapping
Conservative therapy duration ≥ 6 weeks documented ≥ 6 weeks documented High
Neurological deficit documentation Mandatory pre-escalation Mandatory pre-escalation High
MRI confirmation requirement Required within 3 months Required, timing flexible Moderate
Red-flag symptom criteria Standardized NICE-aligned Partially standardized Moderate
Escalation timing threshold Defined in DBC pathway Specialist discretion-based Low — Manual Review
Failed conservative documentation Structured GP record Variable documentation format Low — Manual Review
Age-Weighted Baseline
Physiological reserve modeled by age cohort before outcome comparison.
Comorbidity Indexing
Concurrent condition burden integrated into expected outcome baseline.
Frailty Calibration
Frailty markers adjusted to prevent penalizing high-dependency populations.
Case-Mix Normalization
Tertiary centre complexity contextualized — never compared as equivalent to routine care.

Accountability
Before Automation

Designed for high-sensitivity healthcare environments. AI functions as a supervised analytical layer — never as a decision authority.

01 —

Human-in-the-Loop Architecture

Every governance signal is supervised. No reimbursement decision, institutional evaluation, or compliance signal is executed without human oversight. Final decisions remain with insurance institutions, clinical review boards, and governance bodies.

Mandatory Supervision No Auto-Approval Institutional Authority
02 —

Explainable AI (XAI) Protocols

No opaque probability scores are delivered without traceable reasoning. Each signal includes its trigger parameter, reference threshold, divergence metric, risk-adjustment modifier, and mapping confidence level. Transparency is structural, not optional.

Full Signal Traceability Audit Pathways Version Control
03 —

EU AI Act & GDPR Alignment

Designed under high-accountability AI governance principles with GDPR data minimisation standards and purpose limitation requirements. Role-based access control ensures data remains purpose-bound across all operational layers.

EU AI Act Principles GDPR Compliant Data Minimisation
04 —

Bias Monitoring & Fairness Controls

Periodic evaluation of signal distribution asymmetry, specialty-level variance, and institutional clustering effects. High-complexity centres treating difficult populations are protected by architectural design — complexity is contextualized, not penalized.

Signal Distribution Audit Specialty Variance Review Complexity Protection
05 —

Academic Oversight Consortium

The Indication Matrix is developed and recalibrated by an academic consortium under periodic review to ensure clinical validity, evidence alignment, threshold updates, and risk adjustment recalibration. Institutions may initiate recalibration dialogue.

Living Governance Instrument Evidence Integration Institutional Challenge Rights
06 —

Coordination Without Concentration

Identity data never crosses borders. Encrypted tokenization ensures no personal identifiers are transmitted. Each operational layer is separated by role with restricted data access privileges. Cross-domain data aggregation is prevented by architectural design.

Zero Cross-Border Identity Tokenized Architecture Role Separation

Kayseri — Dordrecht
Governance Sandbox

The first validation corridor structures an already-existing migration-linked care flow. The pilot does not create mobility — it structures a pattern that exists.

// Active Validation Corridor — Phase 1
Kayseri
Türkiye
~2,700 KM
Dordrecht
Netherlands
01

Patient contacts Dutch family physician

GP evaluates clinical necessity of examination in Kayseri under existing gatekeeper logic.

02

Encrypted referral token generated

No personal identifiers cross borders. Identity and clinical data are architecturally separated.

03

Clinical assessment in Kayseri

Participating clinical partner operates under pre-alignment training and documentation standards.

04

Report returns to originating GP

Clinical report transmitted directly back to the Dutch GP system. Gatekeeper continuity preserved.

05

Governance signal generated

Indication alignment, complication context, and mapping confidence evaluated under supervised AI architecture.

Phase 1
Active corridor validation in Kayseri–Dordrecht corridor
4
Expansion phases toward multi-corridor European network
0
Personal identifiers transmitted cross-border
Institutional autonomy preserved throughout participation

The corridor measures signal consistency, inter-review agreement, variance reduction index, dispute cycle length, and institutional feedback. Expansion follows measurable validation — evidence before scale.

ACTIVE Phase 1 — NL–TR corridor validation
NEXT Phase 2 — Matrix recalibration & institutional onboarding
PLANNED Phase 3 — Expanded corridor replication within Europe
PLANNED Phase 4 — Multi-corridor structured governance network