Abstract
BACKGROUND: The opaque nature of artificial intelligence (AI) algorithms has led to distrust in medical contexts, particularly in the treatment and monitoring of atrial fibrillation. Although previous studies in explainable AI have demonstrated potential to address this issue, they often focus solely on electrocardiography graphs and lack real-world field insights. OBJECTIVE: We addressed this gap by incorporating standardized clinical interpretation of electrocardiography graphs into the system and collaborating with cardiologists to co-design and evaluate this approach using real-world patient cases and data. METHODS: We conducted a 3-stage iterative design process with 23 cardiologists to co-design, evaluate, and pilot an explainable AI application. In the first stage, we identified 4 physician personas and 7 explainability strategies, which were reviewed in the second stage. A total of 4 strategies were deemed highly effective and feasible for pilot deployment. On the basis of these strategies, we developed a progressive web application and tested it with cardiologists in the third stage. RESULTS: The final progressive web application prototype received above-average user experience evaluations and effectively motivated physicians to adopt it owing to its ease of use, reliable information, and explainable functionality. In addition, we gathered in-depth field insights from cardiologists who used the system in clinical contexts. CONCLUSIONS: Our study identified effective explainability strategies, emphasized the importance of curating actionable features and setting accurate expectations, and suggested that many of these insights could apply to other disease care contexts, paving the way for future real-world clinical evaluations.