Project-derived · sanitized
Risk Register (sanitized)
Converts diffuse concern into named, graded, owned, and reviewable risks. The design point is that no risk exists without an owner, a mitigation, and a review date.
What this artifact is for
A risk register turns “we are worried about the model” into a structure an organization can act on. Every entry has a named owner, a mitigation, and a review date. Without an owner, nobody manages the risk. Without a mitigation, it is only a complaint. Without a review date, it gets forgotten.
This risk register is the instrument from the governance pack (v0.2) I developed for my patient-facing cardiometabolic digital twin, aligned with the bounded cardiometabolic use case in my Viewpoint. The entries are a post-deployment projection in the twin’s own domain: the cardiovascular and metabolic risks the system would need to manage once deployed. The twin is pre-deployment, so these are projected risks used to exercise the structure, not figures from a live system. No confidential project or patient detail is included.
Fixed metadata
| Field | Value |
|---|---|
| Data provenance | Wearable streams (heart rate, HRV, sleep, activity), EHR labs (HbA1c, lipids, blood pressure), validated self-reports, model output logs |
| Model version | Cardiometabolic Risk Model — pre-deployment build (version pinned at validation before any pilot) |
| Approval owner | AI Governance Lead + Patient Safety Committee |
| Effective date | Not yet in force (pre-deployment) |
| Version | v0.2 |
| Last updated | July 2026 |
| Known limitation | Pre-deployment projection: risk grading reflects anticipated risks and will be revised against real monitoring evidence once deployed |
Register
| ID | Risk | Category | Likelihood | Impact | Level | Risk owner | Existing control | Mitigation | Review |
|---|---|---|---|---|---|---|---|---|---|
| R1 | Model sensitivity for flagging accelerating cardiovascular risk fell from 86% to 72%; patients on a deteriorating cardiometabolic trajectory may be missed | Performance / patient safety | Medium | High | High | Governance Lead + Clinical Lead | Monthly performance monitoring | Start drift analysis; add clinician review; assess threshold change | 2 weeks |
| R2 | High-risk trajectory flags rose from about 80 to about 150 per week and PPV fell to 30%, producing alert fatigue | Workflow / efficiency | High | Medium | High | Clinical Lead | Clinician feedback channel | Tune thresholds; tiered alerts; log handling time | 2 weeks |
| R3 | Older patients and women show a higher miss rate, risking inequitable harm | Fairness / patient safety | Medium | High | High | Patient Safety / Equity Committee | No systematic subgroup audit yet | Age- and sex-stratified performance audit; restrict use if needed | 1 week |
| R4 | The twin surfaced elevated stress and disrupted-sleep signals to the patient as a psychological inference, risking stigma | Privacy / stigma | Medium | Medium-high | Medium-high | Governance Lead + Clinical Lead | Inference-display policy | Keep psychological signals as internal features; show trajectory only; patient opt-out | 1 week |
| R5 | Continued patient-facing operation during degradation may deliver misleading trajectory narratives | Patient safety / trust | Medium | High | High | Hospital management + Patient Safety Committee | Clinician review | Temporarily restrict to advisory; require clinician review before patient-facing output | 48 hours |
The design principle
Each risk must carry three things: a risk owner, a mitigation, and a review date. The register also separates who identifies a risk, who owns a control, who owns the risk, and who has authority to accept residual risk, so that residual risk is accepted by people with the authority and resources to manage it, not defaulted onto whoever understands the model best.
Citation metadata
| Field | Value |
|---|---|
| Title | Risk Register (sanitized) |
| Author | Xiaoyan Qian |
| Public page version | v0.2 |
| Publication date | 2026-08-03 |
| Stable URL | https://xiaoyanqian.com/artifacts/risk-register/ |
| Licence | All rights reserved |
| Suggested citation | Qian, X. (2026). Risk Register (sanitized) (v0.2). https://xiaoyanqian.com/artifacts/risk-register/ |