eprintid: 10163386 rev_number: 9 eprint_status: archive userid: 699 dir: disk0/10/16/33/86 datestamp: 2023-01-19 09:58:17 lastmod: 2024-10-17 15:41:45 status_changed: 2023-01-19 09:58:17 type: article metadata_visibility: show sword_depositor: 699 creators_name: Hogg, Henry David Jeffry creators_name: Al-Zubaidy, Mohaimen creators_name: Technology Enhanced Macular Services Study Reference Group, creators_name: Talks, James creators_name: Denniston, Alastair K creators_name: Kelly, Christopher J creators_name: Malawana, Johann creators_name: Papoutsi, Chrysanthi creators_name: Teare, Marion Dawn creators_name: Keane, Pearse A creators_name: Beyer, Fiona R creators_name: Maniatopoulos, Gregory title: Stakeholder Perspectives of Clinical Artificial Intelligence Implementation: Systematic Review of Qualitative Evidence ispublished: pub subjects: MOOR divisions: UCL divisions: B02 divisions: C07 divisions: D08 keywords: artificial intelligence, computerized decision support, implementation, qualitative evidence synthesis, qualitative research, systematic review, Humans, Artificial Intelligence, Health Personnel, Machine Learning, Qualitative Research note: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. abstract: BACKGROUND: The rhetoric surrounding clinical artificial intelligence (AI) often exaggerates its effect on real-world care. Limited understanding of the factors that influence its implementation can perpetuate this. OBJECTIVE: In this qualitative systematic review, we aimed to identify key stakeholders, consolidate their perspectives on clinical AI implementation, and characterize the evidence gaps that future qualitative research should target. METHODS: Ovid-MEDLINE, EBSCO-CINAHL, ACM Digital Library, Science Citation Index-Web of Science, and Scopus were searched for primary qualitative studies on individuals' perspectives on any application of clinical AI worldwide (January 2014-April 2021). The definition of clinical AI includes both rule-based and machine learning-enabled or non-rule-based decision support tools. The language of the reports was not an exclusion criterion. Two independent reviewers performed title, abstract, and full-text screening with a third arbiter of disagreement. Two reviewers assigned the Joanna Briggs Institute 10-point checklist for qualitative research scores for each study. A single reviewer extracted free-text data relevant to clinical AI implementation, noting the stakeholders contributing to each excerpt. The best-fit framework synthesis used the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. To validate the data and improve accessibility, coauthors representing each emergent stakeholder group codeveloped summaries of the factors most relevant to their respective groups. RESULTS: The initial search yielded 4437 deduplicated articles, with 111 (2.5%) eligible for inclusion (median Joanna Briggs Institute 10-point checklist for qualitative research score, 8/10). Five distinct stakeholder groups emerged from the data: health care professionals (HCPs), patients, carers and other members of the public, developers, health care managers and leaders, and regulators or policy makers, contributing 1204 (70%), 196 (11.4%), 133 (7.7%), 129 (7.5%), and 59 (3.4%) of 1721 eligible excerpts, respectively. All stakeholder groups independently identified a breadth of implementation factors, with each producing data that were mapped between 17 and 24 of the 27 adapted Nonadoption, Abandonment, Scale-up, Spread, and Sustainability subdomains. Most of the factors that stakeholders found influential in the implementation of rule-based clinical AI also applied to non-rule-based clinical AI, with the exception of intellectual property, regulation, and sociocultural attitudes. CONCLUSIONS: Clinical AI implementation is influenced by many interdependent factors, which are in turn influenced by at least 5 distinct stakeholder groups. This implies that effective research and practice of clinical AI implementation should consider multiple stakeholder perspectives. The current underrepresentation of perspectives from stakeholders other than HCPs in the literature may limit the anticipation and management of the factors that influence successful clinical AI implementation. Future research should not only widen the representation of tools and contexts in qualitative research but also specifically investigate the perspectives of all stakeholder HCPs and emerging aspects of non-rule-based clinical AI implementation. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021256005; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256005. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/33145. date: 2023-01-10 date_type: published publisher: JMIR Publications Inc. official_url: https://doi.org/10.2196/39742 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2000407 doi: 10.2196/39742 medium: Electronic pii: v25i1e39742 lyricists_name: Denniston, Alastair lyricists_name: Keane, Pearse lyricists_id: ADENN30 lyricists_id: KPEAR28 actors_name: Bracey, Alan actors_id: ABBRA90 actors_role: owner full_text_status: public publication: Journal of Medical Internet Research volume: 25 article_number: e39742 event_location: Canada issn: 1439-4456 citation: Hogg, Henry David Jeffry; Al-Zubaidy, Mohaimen; Technology Enhanced Macular Services Study Reference Group; Talks, James; Denniston, Alastair K; Kelly, Christopher J; Malawana, Johann; ... Maniatopoulos, Gregory; + view all <#> Hogg, Henry David Jeffry; Al-Zubaidy, Mohaimen; Technology Enhanced Macular Services Study Reference Group; Talks, James; Denniston, Alastair K; Kelly, Christopher J; Malawana, Johann; Papoutsi, Chrysanthi; Teare, Marion Dawn; Keane, Pearse A; Beyer, Fiona R; Maniatopoulos, Gregory; - view fewer <#> (2023) Stakeholder Perspectives of Clinical Artificial Intelligence Implementation: Systematic Review of Qualitative Evidence. Journal of Medical Internet Research , 25 , Article e39742. 10.2196/39742 <https://doi.org/10.2196/39742>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10163386/1/PDF-2.pdf