The voice of healthcare: introducing digital decision support systems into clinical practice - a qualitative study

Physician's autonomy in the face of AI support: walking the ethical tightrope

The introduction of AI support tools raises questions about the normative orientation of medical practice and the need to rethink its basic concepts. One of these concepts that is central to the discussion is the physician’s autonomy and its appropriateness in the face of high-powered AI applications. In this essay, a differentiation of the physician’s autonomy is made on the basis of a conceptual analysis. It is argued that the physician’s decision-making autonomy is a purposeful autonomy. The physician’s decision-making autonomy is fundamentally anchored in the medical ethos for the purpose to promote the patient’s health and well-being and to prevent him or her from harm. It follows from this purposefulness that the physician’s autonomy is not to be protected for its own sake, but only insofar as it serves this end better than alternative means. We argue that today, given existing limitations of AI support tools, physicians still need physician’s decision-making autonomy. For the possibility of physicians to exercise decision-making autonomy in the face of AI support, we elaborate three conditions: (1) sufficient information about AI support and its statements, (2) sufficient competencies to integrate AI statements into clinical decision-making, and (3) a context of voluntariness that allows, in justified cases, deviations from AI support. If the physician should fulfill his or her moral obligation to promote the health and well-being of the patient, then the use of AI should be designed in such a way that it promotes or at least maintains the physician’s decision-making autonomy.

Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review

BACKGROUND

Clinical decision support systems (CDSSs) have the potential to improve quality of care, patient safety, and efficiency because of their ability to perform medical tasks in a more data-driven, evidence-based, and semi-autonomous way. However, CDSSs may also affect the professional identity of health professionals. Some professionals might experience these systems as a threat to their professional identity, as CDSSs could partially substitute clinical competencies, autonomy, or control over the care process. Other professionals may experience an empowerment of the role in the medical system. The purpose of this study is to uncover the role of professional identity in CDSS implementation and to identify core human, technological, and organizational factors that may determine the effect of CDSSs on professional identity.

METHODS

We conducted a systematic literature review and included peer-reviewed empirical studies from two electronic databases (PubMed, Web of Science) that reported on key factors to CDSS implementation and were published between 2010 and 2023. Our explorative, inductive thematic analysis assessed the antecedents of professional identity-related mechanisms from the perspective of different health care professionals (i.e., physicians, residents, nurse practitioners, pharmacists).

RESULTS

One hundred thirty-one qualitative, quantitative, or mixed-method studies from over 60 journals were included in this review. The thematic analysis found three dimensions of professional identity-related mechanisms that influence CDSS implementation success: perceived threat or enhancement of professional control and autonomy, perceived threat or enhancement of professional skills and expertise, and perceived loss or gain of control over patient relationships. At the technological level, the most common issues were the system's ability to fit into existing clinical workflows and organizational structures, and its ability to meet user needs. At the organizational level, time pressure and tension, as well as internal communication and involvement of end users were most frequently reported. At the human level, individual attitudes and emotional responses, as well as familiarity with the system, most often influenced the CDSS implementation. Our results show that professional identity-related mechanisms are driven by these factors and influence CDSS implementation success. The perception of the change of professional identity is influenced by the user's professional status and expertise and is improved over the course of implementation.

CONCLUSION

This review highlights the need for health care managers to evaluate perceived professional identity threats to health care professionals across all implementation phases when introducing a CDSS and to consider their varying manifestations among different health care professionals. Moreover, it highlights the importance of innovation and change management approaches, such as involving health professionals in the design and implementation process to mitigate threat perceptions. We provide future areas of research for the evaluation of the professional identity construct within health care.

Artificial intelligence for skin cancer detection and classification for clinical environment: a systematic review

Background

Skin cancer is one of the most common forms worldwide, with a significant increase in incidence over the last few decades. Early and accurate detection of this type of cancer can result in better prognoses and less invasive treatments for patients. With advances in Artificial Intelligence (AI), tools have emerged that can facilitate diagnosis and classify dermatological images, complementing traditional clinical assessments and being applicable where there is a shortage of specialists. Its adoption requires analysis of efficacy, safety, and ethical considerations, as well as considering the genetic and ethnic diversity of patients.

Objective

The systematic review aims to examine research on the detection, classification, and assessment of skin cancer images in clinical settings.

Methods

We conducted a systematic literature search on PubMed, Scopus, Embase, and Web of Science, encompassing studies published until April 4th, 2023. Study selection, data extraction, and critical appraisal were carried out by two independent reviewers. Results were subsequently presented through a narrative synthesis.

Results

Through the search, 760 studies were identified in four databases, from which only 18 studies were selected, focusing on developing, implementing, and validating systems to detect, diagnose, and classify skin cancer in clinical settings. This review covers descriptive analysis, data scenarios, data processing and techniques, study results and perspectives, and physician diversity, accessibility, and participation.

Conclusion

The application of artificial intelligence in dermatology has the potential to revolutionize early detection of skin cancer. However, it is imperative to validate and collaborate with healthcare professionals to ensure its clinical effectiveness and safety.

"The Simpler, the Better." A Qualitative Study on Digital Health Transformation in Early Adopter Rheumatology Outpatient Clinics

Workforce shortage and the increasing burden of rheumatic and musculoskeletal diseases lead to extreme time constraints in rheumatology outpatient care. Digital services promise to facilitate care by relieving employees and unleash new capacities. This study aims to explore the perspectives of early adopter health care professionals (HCP) on digital transformation in outpatient rheumatology. In-depth qualitative interviews were conducted with rheumatology nurses and physicians in 3 German rheumatology outpatient clinics, each characterized by an advanced level of digital adaption. Qualitative data were subsequently analyzed using deductive-inductive qualitative content analysis. Interviews with 11 rheumatology nurses and 5 rheumatologists were completed. Three key themes emerged from the qualitative analysis: (i) Digital transformation of care; (ii) impact of digital transformation on health care delivery; and (iii) perceived drivers of successful digitalization. The interviews revealed that digital technologies are widely used throughout the complete patient pathway. Digitalization enables more continuity and flexibility in rheumatology care. Patient information can be electronically obtained in a standardized manner prior to planned visits, enabling an informed consultation and more time for in-depth patient discussion. Although digitalization restructures work, it can also increase the current workload. Improved accessibility for patient calls leads to more work for HCP. Important drivers of successful digital technology implementation are low-threshold and interoperable services, a medical team that is interested and educated in eHealth, and comprehensive patient information and onboarding. Digital transformation is increasingly redefining rheumatology care. While accelerating communication and workflows, improved service accessibility leads to more work for HCP.