A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

Abstract

The clinical decision support system is utilized to translate knowledge into evidence-based practice in clinical settings. Many studies have been conducted to understand users' adoption of the clinical decision support system. A critical review was conducted to understand the theoretical or conceptual frameworks used to inform the studies on the adoption of the clinical decision support system. The review identified 15 theoretical and conceptual frameworks using multiple hybrids of theories and concepts. The Technology Acceptance Model was the most frequently used baseline framework combined with frameworks such as the diffusion of innovation, social theory, longitudinal theory, and so on. The results from these articles yielded multiple concepts influencing the adoption of the clinical decision support system. These concepts can be recategorized into nine major concepts, namely, the information system, person (user or patient), social, organization, perceived benefits, emotions, trustability, relevance (fitness), and professionalism. None of the studies found all the nine concepts. That said, most of them have identified the information system, organization, and person concepts as three of its concepts affecting the use of the clinical decision support system. Within each of the concepts, its subconcepts were noted to be very varied. Yet each of these subconcepts has significantly contributed toward the different facets of the concepts. A pluralistic framework was built using the concepts and subconcepts to provide an overall framework construct for future study on the adoption of the clinical decision support system.

A Conceptual Framework for the Acceptance of Drones

“…A systematic review of research on the public acceptance of GMF and nuclear energy was conducted following the PRISMA guidelines which include the identification of: information sources, search criteria, and study selection criteria (Liberati et al 2009). PRISMA protocols are well supported in the literature and employed in several similar studies (Cameron et al 2014;Khong et al 2015;Pidgeon et al 2015).…”

Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation

“…We will include constructs that we consider relevant to understand the determinants of behavioral change and technology acceptance, but are not included in all contributing frameworks. Example: a recent literature review from Khong et al [ 29 ] identified “threats to professional autonomy” as a determinant of the acceptance of DDSs. It could be argued that this construct could be considered part of the UTAUT’s “performance expectancy.” However, it could be useful to include this construct in the final framework specifically.…”

“…We will map constructs that we consider too specific to more abstract constructs included in other frameworks. Example: the same review from Khong et al [ 29 ] includes “usability” and “computer experience or computer skill” as determinants for DSS acceptability. These two constructs could be mapped to the UTAUT’s “effort expectancy.” Therefore, it could be argued that it would not be necessary to include them in the final framework.…”

“…Finally, in 2015, Khong et al [ 29 ] published a systematic literature review about factors affecting the adoption of clinical decision support systems. They recognized 42 determinants, including: patient clinical status, fitness of task, credibility of system, and patient-user’s relationship.…”

A Conceptual Framework to Study the Implementation of Clinical Decision Support Systems (BEAR): Literature Review and Concept Mapping

“…Similarly, several models attempt to explain the factors influencing the user’s decision to use a technology system routinely [ 33 , 34 ]. Furthermore, several recent studies have identified determinants that are specific to the acceptance of CDSSs [ 35 - 40 ]. When seen together, these frameworks amount to too many concepts for a reasonable research project to use effectively.…”