Artificial Intelligence in Healthcare: From Predictive Models to Generative, Multimodal, and Agentic AI.

Abstract

Artificial intelligence (AI) is increasingly used across the diagnostic pathway, from screening and disease detection to differential diagnosis, prognostic stratification, and treatment-response assessment. This narrative review examines predictive, generative, multi-modal, and agentic AI through a diagnostic-science lens and evaluates the evidence required for translation into clinical practice. Predictive models can identify complex patterns in images, physiological signals, laboratory data, and electronic health records, but high retrospective accuracy does not establish diagnostic utility. Clinical validity and utility depend on the intended use, target population, disease spectrum and prevalence, reference standard, operating threshold, calibration, and the consequences of false-positive and false-negative results. Generative AI may support problem representation, differential diagnosis, information synthesis, and documentation, yet fluent outputs can omit critical alternatives, amplify false premises, or convey unjustified certainty. Multimodal systems may better reflect clinical reasoning by integrating imaging, text, signals, pathology, and molecular data, but they must demonstrate incremental value over the best single-modality test and remain robust to missing data. Agentic systems can coordinate evidence retrieval, test selection, and sequential workflows, thereby increasing the need for bounded permissions, auditability, error recovery, and human escalation. Across all paradigms, a credible pathway to diagnostic implementation requires independent external and prospective validation, representative consecutive patients, subgroup analysis, workflow and human-AI evaluation, clinical impact studies, and post-deployment surveillance. The field should therefore be judged not by model capability alone, but by whether AI measurably improves diagnostic yield, timeliness, safety, equity, and patient-relevant outcomes in real care settings.