The Stakeholder Community met via 1-hour teleconference every other week through October 2019 to discuss stakeholder activities, provide input to Roadmap components, and give feedback on emerging deliverable materials. The three workgroups above likewise met regularly (typically weekly) by teleconference during summer and fall of 2019, with staff support and oversight from the ACTS Project Team. Stakeholder Community and workgroup members also provided input outside teleconferences via edits and comments on online draft documents. In addition to Stakeholder Community and Workgroup meetings, the project team also had many teleconferences and face-to-face meetings with experts and other stakeholders from the Stakeholder Community and beyond to inform the Roadmap.
Figure 12. ACTS Stakeholder Community Workgroups
During the summer of 2019, the AMIA (54) and the ACTS project team formed a Roadmap Workgroup (n=179) that brought together diverse organizations and perspectives to define a stakeholder-driven roadmap to achieve the future vision, building on the deliverables from the first three workgroups. This workgroup produced a presentation that described key actions to achieve the future vision:
In the fall of 2019, several Roadmap Workgroup members delivered this presentation to their organizations and constituencies for consideration and possible action (see Table 1. Roadmap Workgroup Members Who Planned to Deliver Roadmap Presentations to Their Organizations). Many organizations whose staff participated in Roadmap development have already provided support letters indicating plans to align their efforts and investments with Roadmap execution, and many more such support letters are expected. See Appendix G, ACTS Support Letters for these letters.
During the fall and winter of 2019–2020, the Roadmap Workgroup and ACTS project team were in the process incorporating feedback received during the presentations into the Roadmap draft. Central to this work were the explorations into a draft portfolio of potential pilots to begin executing the Roadmap’s recommendations and driving progress toward the future vision. When the COVID‑19 pandemic began to surge in early 2020, the weekly Roadmap Workgroup call agendas and related work pivoted to help workgroup participants cope with the crisis in ways that would advance the pandemic response for members and beyond while also driving progress toward the ACTS Future Vision. In March 2020, AHRQ approved launching the ACTS COVID‑19 Evidence to Guidance to Action Collaborative (55) to enhance the COVID‑19 knowledge ecosystem cycle in the near-term for stakeholders from diverse groups (e.g., CDOs, Government agencies (including AHRQ staff), evidence and guidance producers, health IT vendors, and many others) who were already collaborating to develop the ACTS Roadmap. The Collaborative’s membership was seeded by the ACTS Roadmap Workgroup and has grown substantially since its inception (see Acknowledgements for the combined Roadmap Workgroup and ACTS COVID Collaborative roster).
To aid the pandemic response and advance progress toward the future vision, AHRQ’s ACTS COVID‑19 Evidence to Guidance to Action Collaborative/Learning Community (55) cultivates enhanced information flow around the ecosystem cycle for COVID‑19 in the near-term and advances efforts to make the cycle more computable and effective in the longer term. See Figure 13. Enhanced Knowledge Ecosystem Flow Being Cultivated by ACTS COVID Collaborative Participants for a sampling of current activities and those driving this work.
Figure 13. Enhanced Knowledge Ecosystem Flow Being Cultivated by ACTS COVID Collaborative Participants
This ACTS COVID‑19 Evidence to Guidance to Action Collaborative serves as one of three AHRQ-supported ACTS Roadmap pilots. The other two are the Evidence/Guidance Computability Tools Requirements Pilot, and the VCU-led Patient-driven Care Plan Tool Refinement and Implementation Pilot. See Appendix E, AHRQ-Funded ACTS Pilots for details about the three pilots and their contributions to Roadmap execution.
It is noteworthy that this Roadmap builds on a separate but related AHRQ-supported initiative that produced a stakeholder-driven Opioid Action Plan (OAP) (56). This predecessor project followed a similar approach to defining a shared future vision and stakeholder-identified actions that the different groups could take to advance their business objectives in ways that simultaneously executed that action plan. Pages 35–37 in the OAP present dozens of examples where stakeholders began taking action to advance their business goals in ways that also seeded OAP recommendation implementation. These actions were fostered by the compelling consensus future vision and began while the action plan recommendations were still being finalized before publication. As with this Roadmap, the OAP goal was not for an expert panel to direct the actions of others, but rather to bring together what individual stakeholders contribute—as byproduct of addressing their business imperatives—into a whole greater than the sum of what would otherwise be siloed and fragmented parts much less likely to realize the desired, shared future vision. The support letters received before this ACTS Roadmap was formally published further validate this stakeholder-driven approach to healthcare transformation (Appendix G, ACTS Support Letters).
Table 1. Roadmap Workgroup Members Who Planned to Deliver Roadmap Presentations to Their Organizations
Federal Agencies (6)
Health IT Vendors (10)
Specialty Societies, Associations, Accreditors (5)
Standards, Payers, Guidelines, Others (11)
Collaborative Ventures Network / Arizona Alliance for Community Health Centers
American College of Emergency Physicians (ACEP)
Island Peer Review Organization, Inc. (IPRO)
National Institutes of Health (NIH) (NIDDK)
RWJBarnabas Rutgers Health
Intelligent Medical Objects (IMO)
American Academy of Family Physicians (AAFP)
Patient-Centered CDS Learning Network (PCCDS-LN)
University of Chicago
American Hospital Association
Logica Health, Health Services Platform Consortium (HSPC)
Veterans Health Administration (VHA)
University of Connecticut
Cognitive Medical Systems
Accreditation Council for Continuing Medical Education (ACCME)
Health Information Alliance (HIA), Inc. / Connecticut (CT) Health Information Exchange (HIE) Agency
University of Texas (UT) Southwestern
National Committee for Quality Assurance (NCQA)
Health Level Seven International (HL7)
National Library of Medicine (NLM)
Object Management Group (OMG) / Business Process Management for Healthcare (BPM+ Health)
Ochsner Health System
Mobilizing Computable Biomedical Knowledge (MCBK) Steering Committee
Blue Cross Blue Shield CA
City of Hope National Medical Center
Blue Cross Blue Shield MN
Four Virginia Ambulatory Care Outcomes Research Network (ACORN) practices: VCU Health System Practices, Fairfax Family Practice Centers, Tidewater Physicians Group, Carilion Health System Practices
Cochrane U.S. Network
Guidelines International Network (GIN) North America (NA) / Chicago Metro
 Participation does not imply organizational endorsement. Participants have been engaged to varying degrees.
 Workgroup names link to the participant listing; n= number of workgroup members. The Stakeholder Community and workgroups have continued to expand since their inception and the numbers reflect status as of December 2020.
 Stakeholder community members from VCU, the National Association of Community Health Centers (NACHC), and Health Hats held vetting sessions, collecting feedback from clinical practices in Virginia, health centers in various states, and patients (through online forums). See Care Delivery Future Vision Vetting for details.
 See Appendix H, Acronyms & Abbreviations for definitions.
Earlier versions of this Roadmap have been shared with AHRQ leadership and several other stakeholders, and next steps are under consideration. The Roadmap requests substantial investments from AHRQ and other Federal partners to produce specific deliverables and other results over the next decade. Funding sources for these investments have not yet been identified, though the compelling future vision and stakeholder engagement that the Roadmap has produced so far are intended as enablers to make that happen. Likewise, for the substantial non-Federal investments the Roadmap seeks to leverage in fully achieving the desired transformation to the knowledge-ecosystem-enabled LHS and Quintuple Aim realization. The Roadmap is being shared broadly so that all public and private stakeholders will have an opportunity to review the proposed goals, activities, and deliverables, and consider how these could help them achieve their missions and objectives through the proposed collaborative efforts.
Hopefully, the Roadmap will be fully funded for execution to begin in October 2021 as proposed, modified as needed based on input from funders and other key stakeholders. Even if that doesn't happen, initial work has already begun and will likely expand over time. For example, the AHRQ-funded ACTS pilots (Appendix E, AHRQ-Funded ACTS Pilots) are already building collaborations and developing requirements, tools, implementations, and evaluations for greater knowledge ecosystem computability/interoperability and other enhancements. These pilot efforts build on substantial engagement by many stakeholders from diverse groups (52) to develop the Roadmap. This engagement is amplified by the many stakeholder organizations that already have indicated their intention to align their investments and activities with Roadmap execution (Appendix G, ACTS Support Letters). In addition, related AHRQ investments (e.g., PCORTF dissemination and implementation initiatives (40) and other related enhancements to AHRQ offerings such as CDS Connect, CEDAR, SRDR+, NGC Next-Gen, and others listed in Appendix F, AHRQ Offerings & the Knowledge Ecosystem Cycle) will advance Roadmap execution.
Circulating this Roadmap document more broadly is expected to further amplify this engagement and the synergistic efforts by various stakeholders. That is, by the Roadmap serving as a template for stakeholders to use in enhancing their knowledge ecosystem enhancement planning and execution efforts in ways that promote valuable synergies with those of other interdependent stakeholders. These synergies can help each organization advance their business goals (e.g., related better products and services for their customers, less effort duplication, greater workforce efficiency) while also accelerating progress toward shared public health and care transformation goals.
A critical enabler for realizing these benefits—especially if the Roadmap isn't fully funded in the near term—will be an initial commitment by some public and/or private entity(ies) to form and support the Roadmap Execution Steering Committee. This will ensure that the momentum established by developing the initial shared future vision and Roadmap to achieve it—reinforced by the AHRQ-funded pilots—continues to increase. Obstacles to broadly realizing LHSs and the Quintuple Aim are great, and painfully slow progress will likely continue without such a mechanism for coordinating and accelerating efforts.
All stakeholders from public and private stakeholder entities are encouraged to review this Roadmap and consider:
By working together to realize this Roadmap's future vision and create a knowledge ecosystem that fully enables a virtuous LHS cycle and the Quintuple Aim, long sought transformations in healthcare and public health could finally be at hand.