This ACTS Roadmap outlines four phases over the next decade to deliver a robust knowledge ecosystem that makes evidence, guidance, and tools from AHRQ and others more FAIR, computable, and useful in supporting widespread LHSs that accelerate progress toward the Quintuple Aim. For each phase, specific actions are defined to produce the deliverables outlined in Figure 1. Summary of Deliverables by Phase. Roadmap actions and resulting deliverables are organized into five categories:

1. Create/Use Governance & Collaboration
2. Enhance/Leverage Infrastructure
3. Enhance/Develop Living, Computable Guidance
4. Enhance Guidance Implementation and Assessment
5. Evaluate/Plan Roadmap Execution

Roadmap-recommended activities for each phase are presented via five tables (one for each category) that outline activities, timelines, and proposed investments. Given the time needed to secure and allocate funding, the proposed start date for Roadmap activities is October 2021. However, significant progress toward the execution of many Roadmap activities has already begun (e.g., as outlined in Appendix E, AHRQ-Funded ACTS Pilots and progress toward collaboration building as outlined in Appendix G, ACTS Support Letters).

Activities necessary to create a knowledge ecosystem that enables computable information to flow seamlessly around the knowledge ecosystem cycle for all stakeholders will take years to accomplish. To ensure a sharp focus on improving health and care delivery, the Roadmap is centered on addressing specific clinical targets that present compelling opportunities to substantially improve public health, and care delivery processes and outcomes. Roadmap activities are designed to deliver near-term improvements in these clinical target areas by having them serve as use cases for enhancing ecosystem cycle function, while also focusing efforts to make the ecosystem cycle more computable and user friendly in the mid-term.

Governance and coordination activities throughout Roadmap execution are intended to catalyze ecosystem function enhancements for many other healthcare improvement imperatives. These activities include addressing barriers that have impeded progress toward the Quintuple Aim in the past - such as counterproductive policies and incentives and information system usability challenges - as well as other barriers discovered during evaluations conducted within each Roadmap phase.

Suggested public investments in Roadmap execution are also summarized in the Investments, ROI, & Next Steps section. These public investments are intended to provide essential "public goods" related to ecosystem function, for example, the AHRQ DKP and other interoperable Federal DKPs that enable stakeholders to use portals and a public marketplace to easily find and access needed tools and resources from public sources. The collaboration mechanisms to coordinate and accelerate interdependent efforts by the public and private sectors to advance knowledge ecosystem cycle function are another public good fostered by this Roadmap.

Work to develop the ACTS Roadmap has reinforced that diverse stakeholders are eager to achieve the future vision enabled by a more robust knowledge ecosystem (see Appendix G, ACTS Support Letters). AHRQ's investment in seeding this ecosystem with the AHRQ DKP can form the nidus to catalyze and coordinate efforts by other stakeholders necessary to achieve the full future vision. AHRQ is already investing in pieces of getting this done (see enhancement efforts in Appendix F, AHRQ Offerings & the Knowledge Ecosystem Cycle)—this Roadmap describes a way to integrate these efforts with each other and with complementary external efforts to get the whole ecosystem working as outlined in Figure 7. LHS Functions That the Knowledge Ecosystem Supports and Figure 11. Digital Healthcare Knowledge Ecosystem.

Likewise, additional investments to enhance the knowledge ecosystem by AHRQ, other U.S. Department of Health and Human Services (HHS) agencies, and other Federal departments (e.g., Defense Health Agency \[DHA\], VHA) can make their knowledge ecosystem-related operations more efficient and effective while accelerating progress toward the future vision. The deliverables and actions outlined throughout these Roadmap phases are intended to be amplified dramatically through private-sector investments that are coordinated with and enhanced by these proposed federally funded efforts. The many support letters that stakeholders began submitting before the Roadmap was formally published reinforces that this is feasible (Appendix G, ACTS Support Letters).