Practical lessons in the global scaling of clinical AI: from one hospital to over a million patients screened

Scaling a successful deep learning tool across three highly distinct settings – in India, Thailand and Australia — offers cross-cutting insights that may inform the expansion of healthcare artificial intelligence globally. This is a preview of subscription content, access via your institution Access options Access Nature and 54 other Nature Portfolio journals Get Nature+, our best-value online-access subscription $32.99 / 30 days cancel any time Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Buy this article - Purchase on SpringerLink - Instant access to the full article PDF. USD 39.95 Prices may be subject to local taxes which are calculated during checkout References Gulshan, V. et al. JAMA 316, 2402–2410 (2016). Krause, J. et al. Ophthalmology 125, 1264–1272 (2018). Gulshan, V. et al. JAMA Ophthalmol. 137, 987–993 (2019). Brant, A. et al. JAMA Netw. Open 8, e250984 (2025). Widner, K. et al. Nat. Med. 29, 1304–1306 (2023). Ruamviboonsuk, P. et al. npj Digit. Med. 2, 25 (2019). Ruamviboonsuk, P. et al. Lancet Digit. Health 4, e235–e244 (2022). Srisubat, A. et al. Ophthalmol. Ther. 12, 1339–1357 (2023). Foreman, J. et al. Med. J. Aust. 206, 402–406 (2017). Chia, M. A. et al. Br. J. Ophthalmol. 108, 268–273 (2024). Qiang, L. et al. Aust. J. Rural Health 33, e70031 (2025). Drinkwater, J. J. et al. Diabetology 6, 146 (2025). Google. https://go.nature.com/4x78bxQ (2026). Bertucio, A. & King, H. Google Open Source Blog https://go.nature.com/3UcQVbZ (21 February 2024). Author information Authors and Affiliations Corresponding author Ethics declarations Competing interests This work was funded by Alphabet Inc. and/or a subsidiary thereof (‘Alphabet’). Authors who are employees of Alphabet may own Alphabet equity as part of the standard compensation package. P.R. is a consultant for Roche, Biocon Biologics, Abbott, 4DMT and Bayer and received research funds from Roche. A.T. and K.R. declare no competing interests. Rights and permissions About this article Cite this article Tiwari, R., Sawhney, R., Widner, K. et al. Practical lessons in the global scaling of clinical AI: from one hospital to over a million patients screened. Nat Med (2026). https://doi.org/10.1038/s41591-026-04643-9 Published: Version of record: DOI: https://doi.org/10.1038/s41591-026-04643-9