Adoption of artificial intelligence applications in clinical practice: insights from a survey of healthcare organizations in Lombardy, Italy

Background: Artificial intelligence (AI) offers transformative potential in healthcare, yet its adoption is hindered by cultural, organizational, and technological barriers, and little is known about their actual use in clinical practice. The aim of this study was to explore current trends in the adoption of AI applications across healthcare organizations in Lombardy, Italy. Methods: This is a survey study that targeted public and private healthcare organizations in Lombardy and conducted between December 2023 and February 2024, with follow-ups between May and June 2024. It included three sections with up to 22 questions: mapping of clinical AI applications, organizational governance of AI, and perceived adoption barriers. Results: Among the 46 responding organizations, 56 AI applications were identified. Most applications focused on analyzing images or structured health data, and supported diagnostic, prognostic, or treatment optimization activities. Routinely used applications were Conformité Européenne-marked, with radiology being the main clinical area of use. Three distinct approaches emerged. While most organizations (57%) have not yet adopted AI applications, among adopters, 13% are developing AI tools, while 30% exclusively purchase commercial solutions. Conclusions: There is considerable variability in both the types and stages of AI applications adopted in clinical practice by healthcare organizations in Lombardy. In terms of functions, most implementations support diagnostic and prognostic tasks, with strong emphasis on imaging-based tools. Regarding innovation strategies, varying approaches, ranging from exclusively purchasing AI applications to hybrid models that include in-house development, were observed. These findings support broader ecosystem efforts to understand and guide AI implementation in healthcare.