More than 85 people, including patients and patient representatives, informaticians, clinicians, electronic health record (EHR) developers, federal representatives, and researchers, attended the second Clinical Decision Support Innovation Collaborative (CDSiC) Annual Meeting in May 2024 to share and discuss efforts to advance patient-centered clinical decision support (PC CDS). Held at the Agency for Healthcare Research and Quality (AHRQ) headquarters in Rockville, MD, the Annual Meeting gathered diverse experts to explore the theme of "Building on a strong foundation to reach new heights: How can we chart a path forward for PC CDS?" 

The Annual Meeting featured interactive presentations on the CDSiC’s work, a keynote presentation on promoting digital health literacy, and a panel highlighting patient advocate perspectives on current and future CDSiC work. Participants shared insights on critical areas of exploration for the field throughout sessions on emerging topics such as the use of artificial intelligence (AI) in digital health care tools, the value proposition for PC CDS, and efforts to measure and strengthen PC CDS.

Advancing PC CDS Through Real-World Projects

AHRQ has long recognized the importance of using a learning health system (LHS) approach to promote the delivery of higher-quality, safer, and more efficient care.[1] AHRQ’s multifaceted work in this area ranges from training the next generation of LHS researchers and developing quality improvement measures to facilitating the adoption and use of decision support tools for clinicians and patients.[2] The CDSiC has supported this important work since its launch in 2021. Throughout the Annual Meeting, participants reflected on CDSiC-developed foundational resources to improve patient care and outcomes through the development and use of PC CDS and pilot projects implementing PC CDS in real-world practice settings. 

While recognizing the pioneering work completed to date, participants emphasized the importance of systematically putting knowledge into practice to support LHSs and achieve the CDSiC vision of a world where patients, caregivers, and care teams have the right information at the right time to make evidence-informed decisions that improve health and well-being for all individuals. With this goal in mind, several meeting participants acknowledged the persistent challenge of filling the gaps between research, innovation, and practice. Narrowing these gaps will require PC CDS stakeholders to understand the unique needs of different health care settings and the factors influencing PC CDS adoption and use as they collaborate directly with clinical sites to enable effective implementation.

To achieve this aim and move the field of PC CDS forward, participants recommended that the CDSiC consider pursuing more real-world pilot studies to gain firsthand knowledge of health system factors that impact the implementation and scaling of PC CDS. 

Exploring New Topics to Promote Meaningful Patient Engagement

To ensure that CDS is truly patient-centered, PC CDS developers must meaningfully engage with patients throughout the development, implementation, and evaluation of PC CDS tools. Additionally, health equity—or the attainment of the highest level of health for all people[3]—remains an essential core aspect of CDS in making sure all patients benefit from CDS advances. While the CDSiC is committed to equity and patient-centeredness, Annual Meeting participants recommended that the CDSiC explore new topics that influence equitable and patient-centered care. For example, participants emphasized the importance of considering patients’ digital health literacy in designing effective PC CDS tools. Digital health literacy is "the ability to appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem."[4] Some experts consider digital health literacy as a “super determinant” of health that impacts all other social determinants, making a clear case for the relevance of digital health literacy to PC CDS.[5] As such, digital health literacy should be included as a key domain to assess when measuring the performance of PC CDS tools. Evaluators should also examine whether PC CDS performance in other key domains, such as engagement with CDS tools, is impacted by digital health literacy.

Annual Meeting participants also discussed the important link between health equity and health literacy. Health literacy encompasses both personal health literacy, or individuals’ ability to understand and use health information, and organizational health literacy, or the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.[6] Health literacy is also closely linked with the accessibility and usability of any PC CDS tool, making it a highly relevant topic for the CDSiC. Patient advocates also discussed how health literacy is a useful tool to empower patients and help level the power dynamics in clinical encounters. Together, these discussions emphasized the importance of exploring a range of patient-centered topics to further advance PC CDS, all while continuing to learn directly from those who will be directly impacted by new technology in health care. 

Building a Value Proposition for PC CDS

Participants also emphasized the need to holistically determine the value proposition of PC CDS, moving beyond calculating only its financial return on investment (ROI). They suggested examining a range of nonfinancial factors to quantify PC CDS benefits, including organizational priorities, patient engagement, patient satisfaction, and incorporation of patient preferences into care decisions. Furthermore, participants discussed the importance of considering value from a multi-stakeholder perspective. Though factors that influence health system administrators’ decisions to invest in PC CDS are important considerations, there are other factors important to patients, payers, and EHR developers that should also be examined in the value proposition. Participants noted that these multifaceted efforts to demonstrate value also provide an opportunity to align PC CDS with incentive programs that reward clinicians for improving care quality and patient outcomes, further encouraging CDS implementation.

Understanding How PC CDS Can Leverage AI and Maintain Trust

 AI holds potential to strengthen health care and PC CDS, including facilitating diagnosis and disease prediction, patient-clinician communication, and the development of clinical summaries. The CDSiC has already launched two real-world PC CDS pilots using AI, known as Quartz and PAIGE. Quartz is a medication adherence app leveraging chatbot technology and large language models, while PAIGE is an interactive AI-powered prototype system to facilitate patient and clinician communication. These pilots help demonstrate AI’s potential to strengthen CDS and facilitate patient-centered care, as well as CDSiC investment in this fast-moving area. 

While Annual Meeting participants recognized the potential of AI, they also stressed the need for a cautious, gradual approach to developing and implementing AI-powered CDS tools. Patient advocates also connected this need with maintaining patient-centeredness, citing an absolute need to rigorously evaluate AI-powered CDS tools for bias that could perpetuate health disparities and to build trust by engaging with marginalized communities throughout development of these new technologies. 

These key considerations—including algorithmic vigilance and equipping patients to make informed decisions about AI tools—point toward potential future CDSiC areas of work, such as exploring potential bias in AI algorithms underlying PC CDS tools.

Looking Forward

The 2024 Annual Meeting provided a valuable opportunity for the CDSiC team to receive feedback directly from diverse stakeholders about key areas to focus on moving forward, including patient-focused areas such as digital health literacy and health system-centered topics such as reducing clinician burden and enhancing PC CDS usability. Stay tuned for more as CDSiC announces upcoming work!