J Am Med Inform Assoc 17:25-33 doi:10.1197/jamia.M3170
  • The practice of informatics
  • Review paper

Computerized clinical decision support for prescribing: provision does not guarantee uptake

  1. Sallie-Anne Pearson2
  1. 1Discipline of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Australia
  2. 2UNSW Cancer Research Centre, University of New South Wales, Sydney, Australia
  3. 3National Prescribing Service Limited, Sydney, Australia
  1. Correspondence to Sallie-Anne Pearson, UNSW Cancer Research Centre, University of New South Wales and Prince of Wales Clinical School, Level 4 Lowy Cancer Research Centre, Sydney, NSW 2052, Australia; sallie.pearson{at}
  1. Contributors All authors contributed to the design, implementation, data analysis and interpretation and production of the manuscript. We acknowledge the contributions of other Study Guidance Group Members: James Reeve, Bryn Lewis, Malcolm Gillies, Michelle Sweidan, Michelle Toms, Adi Smith and Jonathan Dartnell.

  • Received 5 February 2009
  • Accepted 23 September 2009


There is wide variability in the use and adoption of recommendations generated by computerized clinical decision support systems (CDSSs) despite the benefits they may bring to clinical practice. We conducted a systematic review to explore the barriers to, and facilitators of, CDSS uptake by physicians to guide prescribing decisions. We identified 58 studies by searching electronic databases (1990–2007). Factors impacting on CDSS use included: the availability of hardware, technical support and training; integration of the system into workflows; and the relevance and timeliness of the clinical messages. Further, systems that were endorsed by colleagues, minimized perceived threats to professional autonomy, and did not compromise doctor-patient interactions were accepted by users. Despite advances in technology and CDSS sophistication, most factors were consistently reported over time and across ambulatory and institutional settings. Such factors must be addressed when deploying CDSSs so that improvements in uptake, practice and patient outcomes may be achieved.


  • Appendix A is published online only at

  • This work has been presented at the General Practice and Primary Health Care Research Conference, Hobart, June 6, 2008 and the National Medicines Symposium, Canberra, May 14–16, 2008.

  • Funding The project was funded by the Australian Department of Health and Ageing through the National Prescribing Service, as part of a research partnership with the University of Newcastle and the University of New South Wales. Other funders: Australian Department of Health and Ageing.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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