Engaging clinicians early during the development of a graphical user display of an intelligent alerting system at the bedside. (March 2022)

• Record Type: Journal Article
• Authors: Helman, Stephanie; Terry, Martha Ann; Pellathy, Tiffany; Williams, Andrew; Dubrawski, Artur; Clermont, Gilles; Pinsky, Michael R.; Al-Zaiti, Salah; Hravnak, Marilyn
• Is Part Of: International journal of medical informatics. Volume 159(2022)
• Publication Date: 2022-03
• Subjects: Modeling -- Graphical user interface -- Focus groups; AI Artificial Intelligence -- CRI Cardiorespiratory Insufficiency -- EHR Electronic Health Record -- GUI Graphical User Interface -- IDSS Intelligent Decision Support System -- NP Nurse Practitioner -- MD Physician -- RN Registered Nurse -- VS Vital Sign; Medical informatics -- Periodicals; Information science -- Periodicals; Computers -- Periodicals; Medical technology -- Periodicals; Medical Informatics -- Periodicals; Technology, Medical -- Periodicals; Computers; Information science; Medical informatics; Medical technology; Electronic journals; Periodicals; Electronic journals; 610.285
• DOI: 10.1016/j.ijmedinf.2021.104643
• Languages: English
• ISSNs: 1386-5056

Abstract

Abstract: Background: Artificial Intelligence (AI) is increasingly used to support bedside clinical decisions, but information must be presented in usable ways within workflow. Graphical User Interfaces (GUI) are front-facing presentations for communicating AI outputs, but clinicians are not routinely invited to participate in their design, hindering AI solution potential. Purpose: To inform early user-engaged design of a GUI prototype aimed at predicting future Cardiorespiratory Insufficiency (CRI) by exploring clinician methods for identifying at-risk patients, previous experience with implementing new technologies into clinical workflow, and user perspectives on GUI screen changes. Methods: We conducted a qualitative focus group study to elicit iterative design feedback from clinical end-users on an early GUI prototype display. Five online focus group sessions were held, each moderated by an expert focus group methodologist. Iterative design changes were made sequentially, and the updated GUI display was presented to the next group of participants. Results: 23 clinicians were recruited (14 nurses, 4 nurse practitioners, 5 physicians; median participant age ∼35 years; 60% female; median clinical experience 8 years). Five themes emerged from thematic content analysis: trend evolution, context (risk evolution relative to vital signs and interventions), evaluation/interpretation/explanation (sub theme: continuity of evaluation), clinician intuition, and clinical operations. Based on these themes, GUI display changes were made. For example, color and scale adjustments, integration of clinical information, and threshold personalization. Conclusions: Early user-engaged design was useful in adjusting GUI presentation of AI output. Next steps involve clinical testing and further design modification of the AI output to optimally facilitate clinician surveillance and decisions. Clinicians should be involved early and often in clinical decision support design to optimize efficacy of AI tools.