Objectives
To report the development and early formative, user-centered evaluation of a human-centric explainable artificial intelligence (AI)-enabled platform for remote and hybrid phase II cardiovascular rehabilitation (CR), and to discuss its policy and technology implications for adoption and governance in health systems facing access constraints.
Methods
A four-stage methodology was applied: (1) multidisciplinary needs elicitation with cardiovascular rehabilitation professionals; (2) development of machine-learning models for rehabilitation-related risk assessment with integrated explainability; (3) adaptation of expla-nations to clinicians’ and patients’ mental models; and (4) system implementation followed by early multidisciplinary evaluation focused on usability, perceived clinical utility, and safety positioning as a second-opinion decision support tool.
Results
The platform integrates remote patient monitoring, explainable risk assessment, and coordinated multidisciplinary workflows. In early formative evaluation, healthcare professionals reported high acceptance of the explainable second-opinion functionality, highlighting improved interpretability and support for rehabilitation assessment and discharge-related discussions, without replacing clinical judgment.
Conclusions
This study provides an early-stage, policy-relevant account of how explainable AI can be operationalized in cardiovascular rehabilitation while remaining aligned with clinical practice and governance expectations. Rather than demonstrating system-level impact, the con-tribution lies in outlining a practical framework for evaluating adoption conditions, governance needs, and future scale-up of AI-enabled rehabilitation technologies.
Public interest summary
Cardiovascular rehabilitation helps people recover after a heart event, but many patients face barriers to attending in-person programs, particularly due to distance, mobility, or limited service availability. SITeCard is a digital platform developed to support remote and hybrid cardiovascular rehabilitation by organizing patient data and providing clinicians with explainable AI-based risk assessments to inform multidisciplinary discussions. The system was co-designed with healthcare teams to ensure usability and clinically meaningful explanations, and it can be accessed through standard smartphones, including in low-connectivity settings. This study reports early, user-centered evaluation results and highlights policy and governance considerations relevant to the adoption of explainable AI tools in rehabilitation services.
Graphical abstract
Conceptual overview of SITeCard, an early-stage, human-centric explainable AI-enabled platform designed to support remote and hybrid phase II cardiovascular rehabilitation as a second-opinion clinical decision support system. The platform integrates patient data, explainable risk assessment, and multidisciplinary workflows. Patient and system outcomes are shown as policy-relevant targets to be validated in future large-scale evaluations.