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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Research

What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation

Authors: Elisa G. Liberati, Francesca Ruggiero, Laura Galuppo, Mara Gorli, Marien González-Lorenzo, Marco Maraldi, Pietro Ruggieri, Hernan Polo Friz, Giuseppe Scaratti, Koren H. Kwag, Roberto Vespignani, Lorenzo Moja

Published in: Implementation Science | Issue 1/2017

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Abstract

Background

Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption.

Methods

Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation.

Results

We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning.

Conclusions

Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.
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Metadata
Title
What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation
Authors
Elisa G. Liberati
Francesca Ruggiero
Laura Galuppo
Mara Gorli
Marien González-Lorenzo
Marco Maraldi
Pietro Ruggieri
Hernan Polo Friz
Giuseppe Scaratti
Koren H. Kwag
Roberto Vespignani
Lorenzo Moja
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0644-2

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