Background The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has been found that OHI can affect the physician-patient relationship by influencing patient behaviors. Objective This study aims to systematically investigate the impact of OHI-seeking behavior on the physician-patient relationship. Methods Literature retrieval was conducted on 4 databases (Web of Science, PubMed, China National Knowledge Infrastructure, SinoMed), and the time limit for literature publication was before August 1, 2021. Results We selected 53 target papers (42 [79%] English papers and 11 [21%] Chinese papers) that met the inclusion criteria. Of these, 31 (58%) papers believe that patients’ OHI behavior can enable them to participate in their own medical care, improve patient compliance, and improve the physician-patient relationship. In addition, 14 (26%) papers maintain a neutral attitude, some believing that OHI behavior has no significant effect on doctors and patients and others believing that due to changes in the factors affecting OHI behavior, they will have a negative or a positive impact. Furthermore, 8 (15%) papers believe that OHI search behavior has a negative impact on doctors and patients, while 6 (11%) papers show that OHI reduces Chinese patients’ trust in doctors. Conclusions Our main findings showed that (1) OHI-seeking behavior has an impact on patients' psychology, behavior, and evaluation of doctors; (2) whether patients choose to discuss OHI with doctors has different effects on the physician-patient relationship; and (3) the negative impact of OHI on China’s internet users is worthy of attention. Due to the low quality of OHI, poor health information literacy, short physician-patient communication time, and various types of negative news, patients' trust in doctors has declined, thus affecting the physician-patient relationship. Improvement of people's health information literacy and the quality of OHI are important factors that promote the positive impact of OHI on the physician-patient relationship.

Background. Artificial intelligence (AI) has developed rapidly, and its application extends to clinical decision support system (CDSS) for improving healthcare quality. However, the interpretability of AI-driven CDSS poses significant challenges to widespread application. Objective. This study is a review of the knowledge-based and data-based CDSS literature regarding interpretability in health care. It highlights the relevance of interpretability for CDSS and the area for improvement from technological and medical perspectives. Methods. A systematic search was conducted on the interpretability-related literature published from 2011 to 2020 and indexed in the five databases: Web of Science, PubMed, ScienceDirect, Cochrane, and Scopus. Journal articles that focus on the interpretability of CDSS were included for analysis. Experienced researchers also participated in manually reviewing the selected articles for inclusion/exclusion and categorization. Results. Based on the inclusion and exclusion criteria, 20 articles from 16 journals were finally selected for this review. Interpretability, which means a transparent structure of the model, a clear relationship between input and output, and explainability of artificial intelligence algorithms, is essential for CDSS application in the healthcare setting. Methods for improving the interpretability of CDSS include ante-hoc methods such as fuzzy logic, decision rules, logistic regression, decision trees for knowledge-based AI, and white box models, post hoc methods such as feature importance, sensitivity analysis, visualization, and activation maximization for black box models. A number of factors, such as data type, biomarkers, human-AI interaction, needs of clinicians, and patients, can affect the interpretability of CDSS. Conclusions. The review explores the meaning of the interpretability of CDSS and summarizes the current methods for improving interpretability from technological and medical perspectives. The results contribute to the understanding of the interpretability of CDSS based on AI in health care. Future studies should focus on establishing formalism for defining interpretability, identifying the properties of interpretability, and developing an appropriate and objective metric for interpretability; in addition, the user's demand for interpretability and how to express and provide explanations are also the directions for future research.

BACKGROUND The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has been found that OHI can affect the physician-patient relationship by influencing patient behaviors. OBJECTIVE This study aims to systematically investigate the impact of OHI-seeking behavior on the physician-patient relationship. METHODS Literature retrieval was conducted on 4 databases (Web of Science, PubMed, China National Knowledge Infrastructure, SinoMed), and the time limit for literature publication was before August 1, 2021. RESULTS We selected 53 target papers (42 [79%] English papers and 11 [21%] Chinese papers) that met the inclusion criteria. Of these, 31 (58%) papers believe that patients’ OHI behavior can enable them to participate in their own medical care, improve patient compliance, and improve the physician-patient relationship. In addition, 14 (26%) papers maintain a neutral attitude, some believing that OHI behavior has no significant effect on doctors and patients and others believing that due to changes in the factors affecting OHI behavior, they will have a negative or a positive impact. Furthermore, 8 (15%) papers believe that OHI search behavior has a negative impact on doctors and patients, while 6 (11%) papers show that OHI reduces Chinese patients’ trust in doctors. CONCLUSIONS Our main findings showed that (1) OHI-seeking behavior has an impact on patients' psychology, behavior, and evaluation of doctors; (2) whether patients choose to discuss OHI with doctors has different effects on the physician-patient relationship; and (3) the negative impact of OHI on China’s internet users is worthy of attention. Due to the low quality of OHI, poor health information literacy, short physician-patient communication time, and various types of negative news, patients' trust in doctors has declined, thus affecting the physician-patient relationship. Improvement of people's health information literacy and the quality of OHI are important factors that promote the positive impact of OHI on the physician-patient relationship. INTERNATIONAL REGISTERED REPORT RR2-#23354