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What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation
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 gu...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602839/ https://www.ncbi.nlm.nih.gov/pubmed/28915822 http://dx.doi.org/10.1186/s13012-017-0644-2 |
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author | Liberati, Elisa G. Ruggiero, Francesca Galuppo, Laura Gorli, Mara González-Lorenzo, Marien Maraldi, Marco Ruggieri, Pietro Friz, Hernan Polo Scaratti, Giuseppe Kwag, Koren H. Vespignani, Roberto Moja, Lorenzo |
author_facet | Liberati, Elisa G. Ruggiero, Francesca Galuppo, Laura Gorli, Mara González-Lorenzo, Marien Maraldi, Marco Ruggieri, Pietro Friz, Hernan Polo Scaratti, Giuseppe Kwag, Koren H. Vespignani, Roberto Moja, Lorenzo |
author_sort | Liberati, Elisa G. |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13012-017-0644-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5602839 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-56028392017-09-20 What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation Liberati, Elisa G. Ruggiero, Francesca Galuppo, Laura Gorli, Mara González-Lorenzo, Marien Maraldi, Marco Ruggieri, Pietro Friz, Hernan Polo Scaratti, Giuseppe Kwag, Koren H. Vespignani, Roberto Moja, Lorenzo Implement Sci Research 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13012-017-0644-2) contains supplementary material, which is available to authorized users. BioMed Central 2017-09-15 /pmc/articles/PMC5602839/ /pubmed/28915822 http://dx.doi.org/10.1186/s13012-017-0644-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Liberati, Elisa G. Ruggiero, Francesca Galuppo, Laura Gorli, Mara González-Lorenzo, Marien Maraldi, Marco Ruggieri, Pietro Friz, Hernan Polo Scaratti, Giuseppe Kwag, Koren H. Vespignani, Roberto Moja, Lorenzo What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation |
title | What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation |
title_full | What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation |
title_fullStr | What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation |
title_full_unstemmed | What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation |
title_short | What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation |
title_sort | what hinders the uptake of computerized decision support systems in hospitals? a qualitative study and framework for implementation |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602839/ https://www.ncbi.nlm.nih.gov/pubmed/28915822 http://dx.doi.org/10.1186/s13012-017-0644-2 |
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