Explainable Artificial Intelligence for Tabular Data in Healthcare: A Systematic Review of Methods, Evaluation, and Applications
TL;DR
This systematic review provides a comprehensive analysis of XAI methods specifically applied to tabular healthcare data for classification tasks, revealing that SHAP remains the dominant post-hoc method, achieving strong model fidelity but showing inconsistent alignment with clinical expert reasoning.
Abstract
Explainable Artificial Intelligence (XAI) has emerged as a critical enabler for the adoption of machine learning models in high-stakes domains such as healthcare. While significant progress has been made in XAI for computer vision and natural language processing, tabular data—the predominant format of electronic health records—presents unique challenges and opportunities. This systematic review provides a comprehensive analysis of XAI methods specifically applied to tabular healthcare data for classification tasks. We examine 21 primary studies published between 2020 and the first half of 2026, covering three complementary perspectives: (1) intrinsically interpretable models, (2) post-hoc methods including LIME, SHAP, and their variants, and (3) evaluation frameworks that assess both model-centered fidelity and human-centered clinical alignment. Our analysis reveals that SHAP remains the dominant post-hoc method, achieving strong model fidelity but showing inconsistent alignment with clinical expert reasoning. Key findings include the significant impact of class imbalance on explanation consistency, the importance of clinician-centered evaluation, and the emergence of hybrid approaches integrating XAI with generative AI and transfer learning. We identify critical gaps, including limited adoption of XAI in AutoML pipelines, lack of standardized evaluation metrics, and predominance of single-institution validation studies.