Online Symptom Checkers: Recommendations for a vignette-based clinical evaluation standard (Preprint)

The use of patient-facing online symptom checkers (OSCs) has expanded in recent years, but their accuracy, safety, and impact on patient behaviors and health care systems remain unclear. The lack of a standardized process of clinical evaluation has resulted in significant variation in approaches to OSC validation and evaluation. The aim of this paper is to characterize a set of congruent requirements for a standardized vignette-based clinical evaluation process of OSCs. Discrepancies in the findings of comparative studies to date suggest that different steps in OSC evaluation methodology can significantly influence outcomes. A standardized process with a clear specification for vignette-based clinical evaluation is urgently needed to guide developers and facilitate the objective comparison of OSCs. We propose 15 recommendation requirements for an OSC evaluation standard. A third-party evaluation process and protocols for prospective real-world evidence studies should also be prioritized to quality assure OSC assessment.