The barriers and enablers to the integration of a clinical decision support systems into general practice medical software: A narrative review using a systematic approach

Abstract

Background Clinical decision support systems (CDSS) have become an integral part of clinical software management systems in Australian general practices. These systems encompass a range of tools that support patient data management, medication management, patient diagnosis, decision support, pharmacovigilance, drug control, and clinical guidance. They provide functionalities such as computerised alerts, recalls, reminders, clinical guidelines, patient data reports, documentation templates, clinical workflow tools, and prescribing guidance. In this research we aim to explore the enablers and barriers related to the integration of clinical decision support tools into existing clinical management software systems, by undertaking a systematic search of the literature.Methods For this narrative review, MEDLINE (Web of Science) and Scopus databases were searched for peer reviewed articles published in English between January 1980 and March 2023. All study types that examined clinical decision support in medicine were included in the review.Results Thirty-nine studies were included in this review. Of these studies, most reported CDSS varied widely in application, scope, functionality, type, and complexity. Differences in CDSS technical and clinical interface functionality provide options around the type of prompts delivered to a general practitioner (GP). Passive prompts provide clinical guidance to the GP end-user without requiring any action on their part, while active prompts are automated clinical actions or alerts, which the user must either accept or override to proceed with their workflow. CDSS applications include those for the detection and management of cancer, sepsis, acute pain, hypertension, asthma, diabetes, alcohol and tobacco use, antibiotic prescribing, vaccination, medication adverse events, and pregnancy care. For CDSS to provide maximum utility, co-design between the GP end-user and developer needs to be embedded in the functionality.Conclusion Implementation of an integrative multidisciplinary CDSS is not static, it involves multiple iterations of development and re-design that is based on both staged and ad-hoc usability evaluations. This narrative review found the use of co-design provides opportunities for a deeper understanding of the barriers and enablers to the integration of CDSS in clinical practice. Co-design also facilitates the development of more individualised ‘bespoke’ CDSS so the specific needs of clinician end-users can be fulfilled.

The feasibility of integrating an alcohol screening clinical decision support tool into primary care clinical software: A review and Australian key stakeholder study

“…One vendor described this as a problem that could be overcome "as long as you've got business logic, you understand what you're searching for and understand what the rules are and you can translate that to the system, (then) you can do that." Many of the barriers raised by clinician interviewees align closely with those we identi ed in the literature [27].…”