Evaluating the Clinical Feasibility of an Artificial Intelligence–Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study
Authors: Popescu Christina , Golden Grace , Benrimoh David , Tanguay-Sela Myriam , Slowey Dominique , Lundrigan Eryn , Williams Jérôme , Desormeau Bennet , Kardani Divyesh , Perez Tamara , Rollins Colleen , Israel Sonia , Perlman Kelly , Armstrong Caitrin , Baxter Jacob , Whitmore Kate , Fradette Marie-Jeanne , Felcarek-Hope Kaelan , Soufi Ghassen , Fratila Robert , Mehltretter Joseph , Looper Karl , Steiner Warren , Rej Soham , Karp Jordan F , Heller Katherine , Parikh Sagar V , McGuire-Snieckus Rebecca , Ferrari Manuela , Margolese Howard , Turecki Gustavo 
Published: August 2021

Background
Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence–powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows.

Objective
This study aims to examine the feasibility of an artificial intelligence–powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network–based individualized treatment remission prediction.

Methods
Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews.

Results
Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change.

Conclusions
Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies.

Trial Registration
ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642