Cognitive processes as integrative component for developing expert decision-making systems: a workflow centered framework.

The development of expert decision-making systems, which improve task performance and reduce errors within an intra-operative clinical workspace, is critically dependent on two main aspects: (a) Analyzing the clinical requirements and cognitive processes within the workflow and (b) providing an optimal context for accurate situation awareness through effective intra-operative information visualization. This paper presents a workflow centered framework and its theoretical underpinnings to design expert decision-making systems. The framework integrates knowledge of the clinical workflow based on the requirements within the clinical workspace. Furthermore, it builds upon and integrates the theory of situation awareness into system design to improve decision-making. As an application example, this framework has been used to design an intra-operative visualization system (IVS), which provides image guidance to the clinicians to perform minimally invasive procedure. An evaluative study, comparing the traditional ultrasound guided procedure with the new developed IVS, has been conducted with expert intervention radiologists and medical students. The results reveal significant evidence for improved decision-making when using the IVS. Therefore, it can be stated that this study demonstrates the benefits of integrating knowledge of cognitive processes into system development to support clinical decision-making and hence improvement of task performance and prevention of errors.