Table 2.

Recommendations for further investigation

Domain	Recommendation
Provenance and Transparency	Supply the CDSS alongside an accessible and signposted evidence-base
Threat to autonomy and skills	Include GPs in the development of the tool so it is aligned to their clinical needs and workflow and so that they can recommend it to their peers
Clear communication and management guidance	For any prediction given by the tool, provide an evidence-based management or care guideline for the clinician to follow
	Supply visual communication aids, co-designed with patients, so that clinicians can communicate the outcome of the tool with their patients easily
Sensitivity to wider context	Only release a new tool widely when validation of accuracy, and study of unintended consequences, has occurred in real world settings
	Consider and evaluate contextual effects on accuracy such as age, frailty, and multi-morbidity
	Ensure balance of false positives to false negatives given by tool is appropriate for resource use and does not result in excess harm
User control and flexibility	Allow GP to maintain control, override or dismiss a tool
	Ensure there is a provision to record wider context rationale for over-riding tool use
	Integrate tool appropriately with EHR and ensure self-population from previously recorded data as much as possible
Intrusiveness	Consult with GPs on appropriate balance between having a self-generating pop-up or having a template which can be called up by the GP
Alert proliferation and fatigue	Consider the new tool in the context of all other tools within the system. Is this one really adding value?
	Consider developing technologies which manage multiple tools or prioritise the most important alerts and suppress the rest
	Consider a learning system which learns from the behaviour of GPs and accumulated evidence of the effectiveness of the different tools and alerts to adapt tools’ behaviour
Training and support	Label and signpost online training available for using the tool within the tool itself, e.g. a video showing how it works and how to get the most from it and personalise settings where appropriate
	Sustainability: How expensive and adequate is the support for the tool and will it still be provided over time?