Bridging the Gap: Challenges and Strategies for the Implementation of Artificial Intelligence-based Clinical Decision Support Systems in Clinical Practice.

Objectives: Despite the surge in development of artificial intelligence (AI) algorithms to support clinical decision-making, few of these algorithms are used in practice. We reviewed recent literature on clinical deployment of AI-based clinical decision support systems (AI-CDSS), and assessed the maturity of AI-CDSS implementation research. We also aimed to compare and contrast implementation of rule-based CDSS with implementation of AI-CDSS, and to give recommendations for future research in this area.

Methods: We searched PubMed and Scopus for publications in 2022 and 2023 that focused on AI and/or CDSS, health care, and implementation research, and extracted: clinical setting; clinical task; translational research phase; study design; participants; implementation theory, model or framework used; and key findings.

Results: We selected and described a total of 31 recent papers addressing implementation of AI-CDSS in clinical practice, categorised into four groups: (i) Implementation theories, frameworks, and models (4 papers); (ii) Stakeholder perspectives (22 papers); (iii) Implementation feasibility (three papers); and (iv) Technical infrastructure (2 papers). Stakeholders saw potential benefits of AI-CDSS, but emphasized the need for a strong evidence base and indicated that systems should fit into clinical workflows. There were clear similarities with rule-based CDSS, but also differences with respect to trust and transparency, knowledge, intellectual property, and regulation.

Conclusions: The field of AI-CDSS implementation research is still in its infancy. It can be strengthened by grounding studies in established theories, models and frameworks from implementation science, focusing on the perspectives of stakeholder groups other than healthcare professionals, conducting more real-world implementation feasibility studies, and through development of reusable technical infrastructure that facilitates rapid deployment of AI-CDSS in clinical practice.