Over-Relying on Reliance: Towards Realistic Evaluations of AI-Based Clinical Decision Support

Abstract: As AI-based clinical decision support (AI-CDS) is introduced in more and more aspects of healthcare services, HCI research plays an increasingly important role in designing for complementarity between AI and clinicians. However, current evaluations of AI-CDS often fail to capture when AI is and is not useful to clinicians. This position paper reflects on our work and influential AI-CDS literature to advocate for moving beyond evaluation metrics like Trust, Reliance, Acceptance, and Performance on the AI's task (what we term the "trap" of human-AI collaboration). Although these metrics can be meaningful in some simple scenarios, we argue that optimizing for them ignores important ways that AI falls short of clinical benefit, as well as ways that clinicians successfully use AI. As the fields of HCI and AI in healthcare develop new ways to design and evaluate CDS tools, we call on the community to prioritize ecologically valid, domain-appropriate study setups that measure the emergent forms of value that AI can bring to healthcare professionals.