Identifying barriers to implementing a cardiovascular computerised decision support system (CDSS): a Delphi survey

Abstract

IntroductionIn a technological age, the use of electronic means to assist health professionals in their work appears to have achieved limited adoption. In the USA, for example, it is reported that during 2005, approximately 23.9% of physicians used electronic health records (EHRs) in the ambulatory setting, while only 5% of hospitals used computerised physician order entry systems. Likewise, in the UK, which has an extensive computerised primary healthcare sector, the use of computerised decision support systems (CDSS) is not commonplace. 2 Investigating primary care physicians' use of electronic patient records in Norway, Christensen et al concluded that their full potential had not been reached and that problems of integration and functionality needed to be addressed to achieve this.3 Computerised decision support systems are one type of electronic interface designed to assist clinicians in decision making and risk management and to facilitate shared decision making between health professional and patient. Achieving maximum adoption and usage by primary care professionals requires a comprehensive understanding of which professionals find it attractive and why.This paper -a report of research that obtained health professionals' and industry representatives' opinions on the most effective approach or approaches to the dissemination of an electronic decision support ABSTRACTPurpose This paper reports an evaluation of stakeholders' perspectives and recommendations for the dissemination of a cardiovascular computerised decision support system (CDSS) program. Methods A literature review of dissemination models for health information and decision support aids was undertaken to develop a semi-structured interview protocol outlining a range of dissemination models for distribution. A cross section of eight health professionals and three corporate managers were interviewed to provide as broad a view as possible of eight dissemination models. Data were collected via two questionnaires incorporating the Delphi technique. Perspectives from the corporate managers were collected by telephone interview. Results Financial incentive was the most highly rated dissemination method, followed by joint promotion with a professional body and undergraduate medical education. The lowest average rating was for dividing the program into separate components. Participants provided five other suggestions for dissemination. Suggestions for further exploration include the development of a multi-professional model comprising two or more approaches that is piloted and evaluated. Conclusion Our results provide beneficial information on the potential dissemination of computer decision support systems to health professionals whose uptake of CDSS has not previously been explored. Whether use of a shared decision aid impacts on the decisions made by health professionals working in a team is, however, less evident.

Barriers and Facilitators to Clinical Decision Support Systems Adoption: A Systematic Review

“…Computer literacy of younger generation/ good computer skills (Leslie, et al, 2006) Enhancing user/provider knowledge (Trafton, et al, 2010) Economic incentives to user or provider (Wilson & Opolski, 2009); (Subramanian, et al, 2007); (MacLean, Littenberg, & Gagnon, 2006) Professional body collaboration/endorsement (Wilson & Opolski, 2009) Good training (Varonen, Kortteisto, & Kaila, 2008); (Robertson, et al, 2011) Good prior experience using CDSS (Peek , et al, 2011) …”

Factors that impact the adoption of clinical decision support systems (CDSS) in healthcare settings for evidence-based decision making

“…This can lead to limited understanding of the system's features as well as di culty to interact with the system effectively [27]. This can also be related to individual user's computer literacy as clinicians who routinely use computers are reported to have better adoption of systems such as CDSS [28]. Nonetheless, lack of support and training can limit the users' con dence in the system and ability to resolve any technical issues that may arise, thus discouraging CDSS adoption [29,30].…”