Blockchain Audit Trails Resolve the Electronic Health Record Traceability Problem Created by Generative AI

As large language models generate clinical documentation at scale, electronic health records increasingly contain AI-produced content with no verifiable provenance. The field has named this traceability gap but has not yet specified an architectural solution. Blockchain-based audit logging — append-only, cryptographically chained, and tamper-resistant — provides the answer: a lightweight layer capturing model identity, prompt hash, output fingerprint, and timestamp at generation, creating a verifiable chain of custody before text enters the clinical record. Adopting blockchain audit logging as a standard condition of institutional large language model deployment would resolve this traceability crisis before it becomes irreversible.