As a clinician informatician, I have spent over 20 years working at the intersection of health information technology and policy. Throughout my career, my primary focus has been on ensuring that digital tools enhance interactions between patients and clinicians rather than replace them.

Today, federal agencies are prioritizing transparency, fairness, safety, and patient-centeredness in digital health efforts. These priorities are especially visible in artificial intelligence (AI) and health IT modernization initiatives.

In this evolving landscape, patient-centered clinical decision support (PC CDS) is emerging as a key strategy for delivering personalized, evidence-driven care that is aligned with national health goals. PC CDS encompasses digital health tools—such as electronic health records, mobile apps, and patient portals—that combine clinical evidence with patients’ preferences and values and help patients, caregivers, and care teams make informed choices together. Health management applications and other digital health tools are not just technical solutions—they are strategies for care that listen, learn, and evolve.

As director of NORC’s Health Implementation Science Center, I led the Clinical Decision Support Innovation Collaborative (CDSiC), funded by the Agency for Healthcare Research and Quality (AHRQ). Over the last four years, we developed more than 70 actionable resources and implemented five real-world pilots.

PC CDS empowers patients and caregivers, supports care teams, and improves outcomes by aligning care with what matters most to each patient. PC CDS is delivered through mobile apps and patient portals—meeting people where they make their decisions.

PC CDS is built on four interlocking components: 

1. Knowledge: The evidence behind these tools comes from research that focuses on outcomes that patients care about (i.e., patient-centered outcomes research). 
2. Data: Decision support incorporates patient-contributed data, including information from fitness trackers, medical devices, patient-reported outcomes, and other sources outside the hospital or doctor’s office.  
3. Delivery: Patients can access decision support through digital tools, including apps, chatbots, and patient portals. 
4. Use: These tools help patients engage with their doctors and participate in shared decision-making. 

Scaling PC CDS across health systems requires thoughtful attention to infrastructure and governance. CDSiC identified several key considerations:

• Adopt widely recognized data standards and coding systems to support the integration of patient apps with electronic health records (EHRs). Such standards and workflows would allow patient-contributed data (e.g., from fitness trackers, medical devices, and/or patient-reported outcomes) to flow smoothly into clinical workflows and make it easier for clinicians to access and act on this information. 
• Strengthen privacy and security frameworks to protect patient-contributed data. As the volume and variety of patient-contributed data grow, so does the need to ensure its protection. Specifically, it establishes clear patient expectations and consents, secures data through encryption and access controls, and verifies third-party apps for their data handling practices. 
• Support flexible, standards-aligned innovation that encourages creativity while maintaining trust. Health systems must create space for innovation while allowing developers, researchers, and clinicians to build and test new standards-based PC CDS tools. This balance enables scalable solutions that are interoperable, secure, and responsive to patient needs.

AI-based PC CDS tools have the potential to provide patients with the knowledge and confidence to make better health care decisions. These tools can enhance care delivery and reduce clinician burden, but they also raise important questions around transparency, bias, and accountability. To ensure responsible use of AI in PC CDS that truly supports patient engagement and trust, we must:

• Engage and ensure representation of patients and/or caregivers in design and development
• Build the science of effective PC CDS implementation to support patient engagement
• Develop risk-based policies for deciding when AI use is appropriate and what level of clinician involvement is required
• Periodically reassess to prevent algorithmic drift and verify performance
• Establish policies to promote transparency and patient consent in the use of AI

Human engagement remains central to the success of PC CDS. Meaningful involvement of patients, caregivers, clinicians, and developers throughout the tool development lifecycle—from guideline writing to implementation—ensures that tools are not only technically sound but also usable, relevant, and trusted. When patients and caregivers are engaged as active partners during development of PC CDS tools, everyone benefits.

CDSiC’s work has emphasized PC CDS co-design, continuous feedback, and shared learning. This work has also prioritized understanding and enhancing PC CDS’s “human experience” by carefully considering how the tools integrate into the clinical workflow and the patient’s life flow. These principles are critical to developing and implementing PC CDS tools that reflect diverse needs and reduce unintended burdens.

As PC CDS becomes more integrated into care delivery, there is growing interest in understanding its real-world impact. Evaluation must go beyond clinical outcomes to include patient experience, workflow efficiency, and alignment with national priorities.

CDSiC recommends:

• Developing meaningful evaluation metrics across the full lifecycle of PC CDS
• Leveraging real-world data to monitor performance and guide improvement
• Incorporating user feedback to refine tools over time
• Creating opportunities for shared learning across implementations

PC CDS is not just a health IT category but a strategy for deeply personalized and effective care. With the frameworks, tools, and resources developed by CDSiC, federal policymakers and health system leaders have a clear path to turn vision into practice.

We at NORC’s Health Implementation Science Center believe that health IT should serve people and not the other way around. PC CDS offers a way to ensure that every care decision reflects the voices, values, and needs of the individuals it affects.