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? |