Engaging Multidisciplinary Clinical Users in the Design of an Artificial Intelligence-Powered Graphical User Interface for Intensive Care Unit Instability Decision Support.

Abstract

Critical instability forecast and treatment can be optimized by artificial intelligence (AI)-enabled clinical decision support. It is important that the user-facing display of AI output facilitates clinical thinking and workflow for all disciplines involved in bedside care. Our objective is to engage multidisciplinary users (physicians, nurse practitioners, physician assistants) in the development of a graphical user interface (GUI) to present an AI-derived risk score. Intensive care unit (ICU) clinicians participated in focus groups seeking input on instability risk forecast presented in a prototype GUI. Two stratified rounds (three focus groups [only nurses, only providers, then combined]) were moderated by a focus group methodologist. After round 1, GUI design changes were made and presented in round 2. Focus groups were recorded, transcribed, and deidentified transcripts independently coded by three researchers. Codes were coalesced into emerging themes. Twenty-three ICU clinicians participated (11 nurses, 12 medical providers [3 mid-level and 9 physicians]). Six themes emerged: (1) analytics transparency, (2) graphical interpretability, (3) impact on practice, (4) value of trend synthesis of dynamic patient data, (5) decisional weight (weighing AI output during decision-making), and (6) display location (usability, concerns for patient/family GUI view). Nurses emphasized having GUI objective information to support communication and optimal GUI location. While providers emphasized need for recommendation interpretability and concern for impairing trainee critical thinking. All disciplines valued synthesized views of vital signs, interventions, and risk trends but were skeptical of placing decisional weight on AI output until proven trustworthy. Gaining input from all clinical users is important to consider when designing AI-derived GUIs. Results highlight that health care intelligent decisional support systems technologies need to be transparent on how they work, easy to read and interpret, cause little disruption to current workflow, as well as decisional support components need to be used as an adjunct to human decision-making.