AI-based Decision Support Systems Research Articles

A deep learning system for myopia onset prediction and intervention effectiveness evaluation in children

The increasing prevalence of myopia worldwide presents a significant public health challenge. A key strategy to combat myopia is with early detection and prediction in children as such examination allows for effective intervention using readily accessible imaging technique. To this end, we introduced DeepMyopia, an artificial intelligence (AI)-enabled decision support system to detect and predict myopia onset and facilitate targeted interventions for children at risk using routine retinal fundus images. Based on deep learning architecture, DeepMyopia had been trained and internally validated on a large cohort of retinal fundus images (n = 1,638,315) and then externally tested on datasets from seven sites in China (n = 22,060). Our results demonstrated robustness of DeepMyopia, with AUCs of 0.908, 0.813, and 0.810 for 1-, 2-, and 3-year myopia onset prediction with the internal test set, and AUCs of 0.796, 0.808, and 0.767 with the external test set. DeepMyopia also effectively stratified children into low- and high-risk groups (p < 0.001) in both test sets. In an emulated randomized controlled trial (eRCT) on the Shanghai outdoor cohort (n = 3303) where DeepMyopia showed effectiveness in myopia prevention compared to NonCyc-based model, with an adjusted relative reduction (ARR) of −17.8%, 95% CI: −29.4%, −6.4%. DeepMyopia-assisted interventions attained quality-adjusted life years (QALYs) of 0.75 (95% CI: 0.53, 1.04) per person and avoided blindness years of 13.54 (95% CI: 9.57, 18.83) per 1 million persons compared to natural lifestyle with no active intervention. Our findings demonstrated DeepMyopia as a reliable and efficient AI-based decision support system for intervention guidance for children.

Making Co-Design More Responsible: Case Study on the Development of an AI-Based Decision Support System in Dementia Care.

Emerging technologies such as artificial intelligence (AI) require an early-stage assessment of potential societal and ethical implications to increase their acceptability, desirability, and sustainability. This paper explores and compares 2 of these assessment approaches: the responsible innovation (RI) framework originating from technology studies and the co-design approach originating from design studies. While the RI framework has been introduced to guide early-stage technology assessment through anticipation, inclusion, reflexivity, and responsiveness, co-design is a commonly accepted approach in the development of technologies to support the care for older adults with frailty. However, there is limited understanding about how co-design contributes to the anticipation of implications. This paper empirically explores how the co-design process of an AI-based decision support system (DSS) for dementia caregivers is complemented by explicit anticipation of implications. This case study investigated an international collaborative project that focused on the co-design, development, testing, and commercialization of a DSS that is intended to provide actionable information to formal caregivers of people with dementia. In parallel to the co-design process, an RI exploration took place, which involved examining project members' viewpoints on both positive and negative implications of using the DSS, along with strategies to address these implications. Results from the co-design process and RI exploration were analyzed and compared. In addition, retrospective interviews were held with project members to reflect on the co-design process and RI exploration. Our results indicate that, when involved in exploring requirements for the DSS, co-design participants naturally raised various implications and conditions for responsible design and deployment: protecting privacy, preventing cognitive overload, providing transparency, empowering caregivers to be in control, safeguarding accuracy, and training users. However, when comparing the co-design results with insights from the RI exploration, we found limitations to the co-design results, for instance, regarding the specification, interrelatedness, and context dependency of implications and strategies to address implications. This case study shows that a co-design process that focuses on opportunities for innovation rather than balancing attention for both positive and negative implications may result in knowledge gaps related to social and ethical implications and how they can be addressed. In the pursuit of responsible outcomes, co-design facilitators could broaden their scope and reconsider the specific implementation of the process-oriented RI principles of anticipation and inclusion.

AI-Assisted Decision-Making in Long-Term Care: Qualitative Study on Prerequisites for Responsible Innovation.

Although the use of artificial intelligence (AI)-based technologies, such as AI-based decision support systems (AI-DSSs), can help sustain and improve the quality and efficiency of care, their deployment creates ethical and social challenges. In recent years, a growing prevalence of high-level guidelines and frameworks for responsible AI innovation has been observed. However, few studies have specified the responsible embedding of AI-based technologies, such as AI-DSSs, in specific contexts, such as the nursing process in long-term care (LTC) for older adults. Prerequisites for responsible AI-assisted decision-making in nursing practice were explored from the perspectives of nurses and other professional stakeholders in LTC. Semistructured interviews were conducted with 24 care professionals in Dutch LTC, including nurses, care coordinators, data specialists, and care centralists. A total of 2 imaginary scenarios about AI-DSSs were developed beforehand and used to enable participants articulate their expectations regarding the opportunities and risks of AI-assisted decision-making. In addition, 6 high-level principles for responsible AI were used as probing themes to evoke further consideration of the risks associated with using AI-DSSs in LTC. Furthermore, the participants were asked to brainstorm possible strategies and actions in the design, implementation, and use of AI-DSSs to address or mitigate these risks. A thematic analysis was performed to identify the opportunities and risks of AI-assisted decision-making in nursing practice and the associated prerequisites for responsible innovation in this area. The stance of care professionals on the use of AI-DSSs is not a matter of purely positive or negative expectations but rather a nuanced interplay of positive and negative elements that lead to a weighed perception of the prerequisites for responsible AI-assisted decision-making. Both opportunities and risks were identified in relation to the early identification of care needs, guidance in devising care strategies, shared decision-making, and the workload of and work experience of caregivers. To optimally balance the opportunities and risks of AI-assisted decision-making, seven categories of prerequisites for responsible AI-assisted decision-making in nursing practice were identified: (1) regular deliberation on data collection; (2) a balanced proactive nature of AI-DSSs; (3) incremental advancements aligned with trust and experience; (4) customization for all user groups, including clients and caregivers; (5) measures to counteract bias and narrow perspectives; (6) human-centric learning loops; and (7) the routinization of using AI-DSSs. The opportunities of AI-assisted decision-making in nursing practice could turn into drawbacks depending on the specific shaping of the design and deployment of AI-DSSs. Therefore, we recommend considering the responsible use of AI-DSSs as a balancing act. Moreover, considering the interrelatedness of the identified prerequisites, we call for various actors, including developers and users of AI-DSSs, to cohesively address the different factors important to the responsible embedding of AI-DSSs in practice.

The impact of AI-based decision support systems on nursing workflows in critical care units.

This research examines the effects of artificial intelligence (AI)-based decision support systems (DSS) on the operational processes of nurses in critical care units (CCU) located in Amman, Jordan. The deployment of AI technology within the healthcare sector presents substantial opportunities for transforming patient care, with a particular emphasis on the field of nursing. This paper examines how AI-based DSS affect CCU nursing workflows in Amman, Jordan, using a cross-sectional analysis. A study group of 112 registered nurses was enlisted throughout a research period spanning one month. Data were gathered using surveys that specifically examined several facets of nursing workflows, the employment of AI, encountered problems, and the sufficiency of training. The findings indicate a varied demographic composition among the participants, with notable instances of AI technology adoption being reported. Nurses have the perception that there are favorable effects on time management, patient monitoring, and clinical decision-making. However, they continue to face persistent hurdles, including insufficient training, concerns regarding data privacy, and technical difficulties. The study highlights the significance of thorough training programs and supportive mechanisms to improve nurses' involvement with AI technologies and maximize their use in critical care environments. Although there are differing degrees of contentment with existing AI systems, there is a general agreement on the necessity of ongoing enhancement and fine-tuning to optimize their efficacy in enhancing patient care results. This research provides essential knowledge about the intricacies of incorporating AI into nursing practice, highlighting the significance of tackling obstacles to guarantee the ethical and efficient use of AI technology in healthcare.

CITYTWIN – AI-based Decision Support System for Semantic Search and Analysis of Location-based Information for Urban and Site Planning

CITYTWIN – AI-based Decision Support System for Semantic Search and Analysis of Location-based Information for Urban and Site Planning

AI-Based Decision Support System Optimizing Wireless Sensor Networks for Consumer Electronics in E-Commerce

The purpose of this study is to investigate the potential of AI technology in developing a decision support system that can improve the effectiveness of wireless sensor networks (WSNs) in e-commerce, specifically in enhancing the features of consumer electronics. This research project is focused on optimizing wireless sensor networks for e-commerce consumer electronics by incorporating AI-based decision support systems. The primary objective of this study is to enhance energy efficiency and performance in online shopping platforms. Various algorithms and methodologies are proposed and assessed, including Adaptive Clustering, the Path Selection Algorithm, Fuzzy Logic-Controlled Energy Management, the Genetic Algorithm for Resource Allocation, and Deep Sleep Scheduling. These techniques improve network efficiency and reduce power consumption in e-commerce applications. The study demonstrates that integrating AI in consumer electronics can result in a remarkable 40% increase in energy efficiency. Comparative analyses conducted through simulations and real-world assessments indicate that the proposed methodology outperforms traditional techniques by 35%. This research underscores the vital role of AI in enhancing network performance and energy efficiency in e-commerce. The results suggest that implementing AI-driven strategies in wireless sensor networks for consumer electronics can significantly improve online shopping experiences. AI-based decision support systems can optimize wireless sensor networks for consumer electronics, improving energy efficiency and network performance on online shopping platforms.

Damage Control Resuscitation and Damage Control Surgery

Trauma triggers complex physiological responses with primary and secondary effects vital to understanding and managing trauma impact. "Damage Control" (DC), a concept adapted from naval practices, refers to abbreviated initial surgical care focused on controlling bleeding and contamination, critical for the survival of severely compromised patients. This impacts anaesthesia procedures and intensive care. "Damage Control Resuscitation" (DCR) is an interdisciplinary approach aimed at reducing mortality in severely injured patients, despite potentially increasing morbidity and ICU duration. Current medical guidelines incorporate DC strategies.DC is most beneficial for patients with severe physiological injury, where surgical trauma ("second hit") poses greater risks than delayed treatment. Patient assessment for DC includes evaluating injury severity, physiological reserves, and anticipated surgical and treatment strain. Inadequate intervention can worsen trauma-induced complications like coagulopathy, acidosis, hypothermia, and hypocalcaemia.DCR focuses on rapidly restoring homeostasis with minimal additional burden. It includes rapid haemostasis, controlled permissive hypotension, early blood transfusion, haemostasis optimization, and temperature normalization, tailored to individual patient needs."Damage Control Surgery" (DCS) involves phases like rapid haemostasis, contamination control, temporary wound closure, intensive stabilization, planned reoperations, and final wound closure. Each phase is crucial for managing severely injured patients, balancing immediate life-saving procedures and preparing for subsequent surgeries.Intensive care post-DCS emphasizes stabilizing patients hemodynamically, metabolically, and coagulopathically while restoring normothermia. Decision-making in trauma care is complex, involving precise patient assessment, treatment prioritization, and team coordination. The potential of AI-based decision support systems is noted for their ability to analyse patient data in real-time, aiding in decision-making through evidence-based recommendations.

Improving Interobserver Agreement in Thyroid Nodule Evaluation: A Clinical Review of an AI-Based Decision Support System

Improving Interobserver Agreement in Thyroid Nodule Evaluation: A Clinical Review of an AI-Based Decision Support System

Enable Flexibilisation in FAIRWork’s Democratic AI-based Decision Support System by Applying Conceptual Models Using ADOxx

Decision-making in complex production environments is challenging as the information and knowledge requirements must be constantly observed since the ecosystems they operate in are continuously changing. Artificial intelligence (AI) can tackle complexity in decision-making by making machines more intelligent. But reacting to changing or new problems and related decision processes to facilitate the understanding of the involved humans is an equally important problem. Therefore, decision support systems are required to assist complex decisions and enable flexibility to support the decision-makers. Within this scope, we will introduce the Democratic AI-based Decision Support System (DAI-DSS), which is designed and implemented within the EU-funded FAIRWork project, considering both human and machine actors during decision-making. The FAIRWork project proposes a model-based approach to both express high-level decision scenarios and formally describe the decision processes, which are then used as input for configuring the decision support system to meet concrete decision problems.

Effects of explainable artificial intelligence in neurology decision support.

Artificial intelligence (AI)-based decision support systems (DSS) are utilized in medicine but underlying decision-making processes are usually unknown. Explainable AI (xAI) techniques provide insight into DSS, but little is known on how to design xAI for clinicians. Here we investigate the impact of various xAI techniques on a clinician's interaction with an AI-based DSS in decision-making tasks as compared to a general population. We conducted a randomized, blinded study in which members of the Child Neurology Society and American Academy of Neurology were compared to a general population. Participants received recommendations from a DSS via a random assignment of an xAI intervention (decision tree, crowd sourced agreement, case-based reasoning, probability scores, counterfactual reasoning, feature importance, templated language, and no explanations). Primary outcomes included test performance and perceived explainability, trust, and social competence of the DSS. Secondary outcomes included compliance, understandability, and agreement per question. We had 81 neurology participants with 284 in the general population. Decision trees were perceived as the more explainable by the medical versus general population (P < 0.01) and as more explainable than probability scores within the medical population (P < 0.001). Increasing neurology experience and perceived explainability degraded performance (P = 0.0214). Performance was not predicted by xAI method but by perceived explainability. xAI methods have different impacts on a medical versus general population; thus, xAI is not uniformly beneficial, and there is no one-size-fits-all approach. Further user-centered xAI research targeting clinicians and to develop personalized DSS for clinicians is needed.

Navigating the Implementation Challenges of AI-Based Decision Support Systems in Higher Education

Navigating the Implementation Challenges of AI-Based Decision Support Systems in Higher Education

Humans Supervising Artificial Intelligence – Investigation of Designs to Optimize Error Detection

ABSTRACT Artificial Intelligence (AI) fundamentally changes the way we work by introducing new capabilities. Human tasks shift towards a supervising role where the human confirms or disconfirms the presented decision. In this study, we utilise the signal detection theory to investigate and explain how the performance of human error detection is influenced by specific information design. We conducted two online experiments in the context of AI-supported information extraction and measured the ability of participants to validate the extracted information. In the first experiment, we investigated the mechanism of information provided prior to conducting the error detection task. In the second experiment, we manipulated the design of the presented information during the task and investigated its effect. Both manipulations significantly impacted the error detection performance of humans. Hence our study provides important insights for developing AI-based decision support systems and contributes to the theoretical understanding of human-AI collaboration.

Improving Trust in AI with Mitigating Confirmation Bias: Effects of Explanation Type and Debiasing Strategy for Decision-Making with Explainable AI

With advancements in artificial intelligence (AI), explainable AI (XAI) has emerged as a promising tool for enhancing the explainability of complex machine learning models. However, the explanations generated by an XAI may lead to cognitive biases among human users. To address this problem, this study aims to investigate how to mitigate users’ cognitive biases based on their individual characteristics. In the literature review, we found two factors that can be helpful in remedying biases: 1) debiasing strategies that have been reported to potentially reduce biases in users’ decision-making via additional information or change in information delivery, and 2) explanation modality types. To examine these factors’ effects, we conducted an experiment with a 4 (debiasing strategy) × 3 (explanation type) between-subject design. In the experiment, participants were exposed to an explainable interface that provides an AI’s outcomes with explanatory information, and their behavioral and attitudinal responses were collected. Specifically, we statistically examined the effects of textual and visual explanations on users’ trust and confirmation bias toward AI systems, considering the moderating effects of debiasing methods and watching time. The results demonstrated that textual explanations lead to higher trust in XAI systems compared to visual explanations. Moreover, we found that textual explanations are particularly beneficial for quick decision-makers to evaluate the outputs of AI systems. Next, the results indicated that the cognitive bias can be effectively mitigated by providing users with a priori information. These findings have theoretical and practical implications for designing AI-based decision support systems that can generate more trustworthy and equitable explanations.

AI-based decision support system for enhancing end-of-life value recovery from e-wastes

ABSTRACT The growing diversity and volume of e-waste products are emerging as significant and complex challenges from environmental, economic, and recycling perspectives. This surge not only hampers the effective management and conservation of precious resources and strategically important materials (SIMs) but also intensifies the problem. Addressing this pressing global issue necessitates a holistic and intelligent decision-making model capable of effortlessly handling the vast variety and volume of e-waste products. This paper introduces a novel multi-criteria decision support system (DSS) that combines AI visual recognition with a multi-fuzzy model to precisely determine the optimal End-of-Life (EoL) recovery route. Additionally, the functionality of the proposed DSS is showcased through a pilot implementation and case study examples, emphasising the advantages of a fully automated, reliable, and efficient EoL management for e-waste.

A global cyber-threat intelligence system with artificial intelligence and convolutional neural network

Global cyber-attacks significantly impact the economy, society, organizations, and individuals. Existing research on cyber-attacks lacks in demonstrating Artificial Intelligence (AI) based analytical solutions for providing country-wide cyber threat intelligence. Cyber strategists at a national level require AI-based decision support systems for deciding a country’s cyber posture or preparedness. This paper proposes an AI-based solution that autonomously collects multidimensional cyber-attack data on social media posts on cyber-related outcry. The proposed system provides critical analytical capability in the cyber-threat spectrum and uses sophisticated AI-based algorithms for anomaly detection, prediction, sentiment analysis, location detection, translation, etc. The proposed system was deployed from 11 October 2022 to 31 October 2022. During these 21 days, the system autonomously collected 30,203 records on cyber threats covering multiple dimensions of cyber-threat. These dimensions included country-wide daily cyber-attack records by ransomware, exploits, web threats, spam, malicious mail, network attacks, local infections, and on-demand scan. Moreover, the system performed AI-based acquisition and analysis of 3789 cyber-related tweets from 3402 tweet users in 37 different languages. The system also autonomously translated 893 non-English tweets. The proposed system is the first solution that uses Convolutional Neural Network (CNN) based anomaly detection to detect abnormalities in cyber-threat spectrum worldwide and predict cyber-attacks automatically. The proposed system was demonstrated to provide evidence-based decisions on global cyber threats in multiple platforms, including iOS, Android, and Windows.

Multi-class classification of thyroid nodules from automatic segmented ultrasound images: Hybrid ResNet based UNet convolutional neural network approach

Background and objectivesEarly detection and diagnosis of thyroid nodule types are important because they can be treated more effectively in their early stages. The types of thyroid nodules are generally stated as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), benign follicular, and papillary follicular. The risk of malignancy for AUS/FLUS is typically stated to be between 5 and 15 %, while some studies indicate a risk as high as 25 %. Without complete histology, it is difficult to classify nodules and these diagnostic operations are pricey and risky. To minimize laborious workload and misdiagnosis, recently various AI-based decision support systems have been developed. MethodsIn this study, a novel AI-based decision support system has been developed for the automated segmentation and classification of the types of thyroid nodules. This system is based on a hybrid deep-learning procedure that makes both an automatic thyroid nodule segmentation and classification tasks, respectively. In this framework, the segmentation is executed with some U-Net architectures such as ResUNet and ResUNet++ integrating with the feature extraction and upsampling with dropout operations to prevent overfitting. The nodule classification task is achieved by various deep nets architecture such as VGG-16, DenseNet121, ResNet-50, and Inception ResNet-v2 considering some accurate classification criteria such as Intersection over Union (IOU), Dice coefficient, accuracy, precision, and recall. ResultsIn analysis, a total of 880 patients with ages ranging from 10 to 90 years were included by taking the ultrasound images and demographics. The experimental evaluations showed that ResUNet++ demonstrated excellent segmentation outcomes, attaining remarkable evaluation scores including a dice coefficient of 92.4 % and a mean IOU of 89.7 %. ResNet-50 and Inception ResNet-v2 trained over the images segmented with UNets have shown better performance in terms of achieving high evaluation scores for the classification accuracy such as 96.6 % and 95.0 %, respectively. In addition, ResNet-50 and Inception ResNet-v2 classified AUS/FLUS from the images segmented with UNets with AUC=97.0 % and 96.0 %, respectively. ConclusionsThe proposed AI-based decision support system improves the automatic segmentation performance of AUS/FLUS and it has shown better performance than available approaches in the literature with respect to ACC, Jaccard and DICE losses. This system has great potential for clinical use by both radiologists and surgeons as well.

AI and big data-driven decision support for fostering student innovation in music education at private underground colleges

This study investigates the transformative impact of AI-based Decision Support Systems (DSS) and Big Data Analytics (BDA) on student innovation and employability skills in an era of rapid technological advancement, with a focus on the mediating role of technological acceptance and the moderating role of resource availability. This study, which draws on a wide range of educational contexts and data sources, gives complete knowledge of the complex links between technology adoption, student results, and contextual factors. The results of this study show how AI-based DSS and BDA have a significant impact on musical education. These technological advancements enable tailored instruction and foster students' creative thinking. In order to prepare students for a work market that is rapidly changing, they act as a catalyst for improving employability skills. The study, however, emphasizes the complicated dynamics at work. Technological Acceptance emerges as a major mediating component, underlining the significance of students and instructors freely and effectively accepting technological tools. Furthermore, as a moderating factor, Resource Availability takes center stage, emphasizing the need for equitable access to educational resources to ensure that technology-driven advantages are accessible to all. The results of this study have broad repercussions. The adoption of AI and BDA by educational institutions is encouraged as transformative technologies for enhancing the learning process. Policymakers must create regulations that support equal access to technology and promote an innovative culture in the classroom. This study highlights for students how important it is to adopt new technologies, realizing how important they are in determining both their academic and career paths.

Psychological assessment of AI-based decision support systems: tool development and expected benefits.

This study aimed to develop an evaluation tool that assesses the use of AI-based decision support systems (DSSs) in professional practice from a human-centered perspective. Following the International Organization for Standardization, this perspective aims to ensure that the use of interactive technologies improves users' psychological load experience and behavior, e.g., in the form of reduced stress experience or increased performance. Concomitantly, this perspective attempts to proactively prevent or detect and correct the potential negative effects of these technologies on user load, such as impaired satisfaction and engagement, as early as possible. Based on this perspective, we developed and validated a questionnaire instrument, the Psychological Assessment of AI-based DSSs (PAAI), for the user-centered evaluation of the use of AI-based DSSs in practice. In particular, the instrument considers central design characteristics of AI-based DSSs and the corresponding work situation, which have a significant impact on users' psychological load. The instrument was tested in two independent studies. In Study 1, N = 223 individuals were recruited. Based on the results of item and scale analyses and an exploratory factor analysis, the newly developed instrument was refined, and the final version was tested using a confirmatory factor analysis. Findings showed acceptable-to-good fit indices, confirming the factorial validity of the PAAI. This was confirmed in a second study, which had N = 471 participants. Again, the CFA yielded acceptable-to-good fit indices. The validity was further confirmed using convergent and criterion validity analyses.

AI-based decision support system for public procurement

Tenders are powerful means of investment of public funds and represent a strategic development resource. Thus, improving the efficiency of procuring entities and developing evaluation models turn out to be essential to facilitate e-procurement procedures. With this contribution, we introduce our research to create a supporting system for the decision-making and monitoring process during the entire course of investments and contracts. This system employs artificial intelligence techniques based on natural language processing, focused on providing instruments for extracting useful information from both structured and unstructured (i.e., text) data. Therefore, we developed a framework based on a web app that provides integrated tools such as a semantic search engine, a summariser, an open information extraction engine in the form of triples (subject–predicate–object) for tender documents, and dashboards for analysing tender data.

Barriers and Enablers for Implementation of an Artificial Intelligence-Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews.

Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process.