Clinicians’ Perceptions of an Artificial Intelligence–Based Blood Utilization Calculator: Qualitative Exploratory Study

Abstract

Background According to the US Food and Drug Administration Center for Biologics Evaluation and Research, health care systems have been experiencing blood transfusion overuse. To minimize the overuse of blood product transfusions, a proprietary artificial intelligence (AI)–based blood utilization calculator (BUC) was developed and integrated into a US hospital’s electronic health record. Despite the promising performance of the BUC, this technology remains underused in the clinical setting. Objective This study aims to explore how clinicians perceived this AI-based decision support system and, consequently, understand the factors hindering BUC use. Methods We interviewed 10 clinicians (BUC users) until the data saturation point was reached. The interviews were conducted over a web-based platform and were recorded. The audiovisual recordings were then anonymously transcribed verbatim. We used an inductive-deductive thematic analysis to analyze the transcripts, which involved applying predetermined themes to the data (deductive) and consecutively identifying new themes as they emerged in the data (inductive). Results We identified the following two themes: (1) workload and usability and (2) clinical decision-making. Clinicians acknowledged the ease of use and usefulness of the BUC for the general inpatient population. The clinicians also found the BUC to be useful in making decisions related to blood transfusion. However, some clinicians found the technology to be confusing due to inconsistent automation across different blood work processes. Conclusions This study highlights that analytical efficacy alone does not ensure technology use or acceptance. The overall system’s design, user perception, and users’ knowledge of the technology are equally important and necessary (limitations, functionality, purpose, and scope). Therefore, the effective integration of AI-based decision support systems, such as the BUC, mandates multidisciplinary engagement, ensuring the adequate initial and recurrent training of AI users while maintaining high analytical efficacy and validity. As a final takeaway, the design of AI systems that are made to perform specific tasks must be self-explanatory, so that the users can easily understand how and when to use the technology. Using any technology on a population for whom it was not initially designed will hinder user perception and the technology’s use.

Intensive Care Unit Physicians’ Perspectives on Artificial Intelligence–Based Clinical Decision Support Tools: Preimplementation Survey Study

“…A recent scoping review of guidelines for the development of AI-CDS tools concluded that more focus on implementation strategy is needed for effective integration in the clinical setting [29]. Human-factors research, in the form of qualitative interviews and questionnaires, may enhance the uptake of AI-CDS tools, as this approach may improve the system's design, training process, and implementation strategies [12,17]. We recommend focusing on the important local and sociotechnical context of each preimplementation site to meet the challenge of the "last mile" of implementation [11,21,22,30,31].…”

“…There is a need to study human factors for the safe and effective implementation of AI-CDS tools, as high predictive performance does not ensure acceptance of these technologies [12,13]. Physicians' perspectives on clinical AI have been investigated in survey studies in the fields of psychiatry [14], gastroenterology [15], diagnostic pathology [16], and cardiology [17], as well as across specialties [18][19][20].…”

An integrative review on the acceptance of artificial intelligence among healthcare professionals in hospitals

“…Although it can be stated that AI-based prediction systems have shown to result in lower error rates than traditional systems 55 , 56 , it may be argued that systems taking over simple tasks are deemed more reliable and trustworthy and are therefore more widely accepted than AI-based systems operating on complex tasks such as surgical robots. Furthermore, Choudhury et al 3 , who studied the acceptability of an AI-based blood utilization calculator argued that AI-based systems are often based on data from a norm-typical patient population; however, if the system is applied to unanticipated patient populations (e.g. patients with sickle cell disease), the AI-based recommendation may become inadequate.…”

“…AI is a domain of computer science that is involved in the development of technology that is able to excerpt underlying information from a data set and transform them into operative knowledge. This transformation is based on algorithms that could either be predetermined or adaptive 3 . The term AI was coined in 1956 by John McCarthy but is often connected to the now so-called Turing test.…”

Care providers’ perception of artificial intelligence: focus on workload, risk, trust, clinical decision-making, and clinical integration.

“…The study obtained ethical approval from the Stevens Institute of Technology, New Jersey, USA (IRB ID 2022-007) (Choudhury, 2022b). We distributed an online semi-structured survey to the active healthcare practitioners residing in the states.…”