Table 4.

Future directions for PC CDS

Current challenges	Areas for future activities
Prioritization   Absence of patient input in prioritizing topics for PC CDS Lack of guidelines for multiple chronic conditions	Establish methods to incorporate the patient voice in evidence prioritization.
	Expand research and development of PC CDS that incorporate guidelines for multiple conditions in a patient-centric way. Specifically, understand patient needs and priorities by engaging with patients and caregivers through qualitative research. Solicit their responses to use cases to clarify what PC CDS can and should do.
Authoring   Variations in guideline translation Keeping PC CDS up to date Lack of patient-centered terminology standards	Accelerate clinical knowledge translation into PC CDS by leveraging ongoing initiatives on open standards—eg, Mobilizing Computable Biomedical Knowledge (MCBK), which is supporting an ecosystem built on open standards for accessing biomedical knowledge–(make knowledge Findable, universally Accessible, highly Interoperable, and readily Reusable; ie, FAIR principles).59
	Standardize publication of real-world evidence in computable forms, so that this evidence can be automatically converted to PC CDS, thereby limited variability in interpretation.
	Standardize and expand the terminologies for PC CDS data elements.
Implementation   Limited understanding of patient decision-making Aligning PC CDS modalities with patients’ daily lives Lack of PC CDS integration into clinical workflows	Engage in PC CDS codesign activities with patients to understand their needs, desires, expectations, strengths, and limitations.
	Establish industry-wide principles on effective ways to deliver patient-facing PC CDS and principles for implementing PC CDS to support patients.
	Explore how PC CDS can be delivered through multiple modalities to support patient–provider SDM about risk and options.
	Enhance standards-based application programming interfaces (APIs) for sharing information between apps and with EHRs to facilitate communication between provider and patient devices. This includes the development of new FHIR resources and implementation guides and improving the performance and availability of existing FHIR resources in current implementations.
	Focus on prototype software that creates an acceptable workflow between patients and providers for requesting, capturing, and sharing PGHD.
Measuring   Lack of studies that measure clinical outcomes Limited studies that measure patient and provider engagement	Measure more substantive targeted outcomes for PC CDS effectiveness, impacts of PC CDS on clinical outcomes, and research on effective ways to engage patients through PC CDS.
	Engage patients and caregivers across the measurement lifecycle—from selecting outcomes to be tested, to designing the study and intervention, and ultimately contextualizing results.
External factors   Lack of patient and provider trust Concerns regarding the privacy and security of patient data	Define standards to support the metadata used to communicate trust eg, for data provenance standards. These would be part of consumable artifacts to enhance the ease of sharing and likelihood of trusting PC CDS artifacts.60
	Increase transparency through development of rating systems, professional endorsements, and other safeguards to protect patient health, safety, and privacy.
	Develop guidance on best practices for health app developers and/or a rating system for the health app industry to certify they have met certain safety and quality criteria for, eg, plain language information on source of recommendations, any modifications to recommendations that have been tailored to patient-specific preferences and conditions.