Table 6
Specifics of the computerized clinical decision support system (CDSS) impacting on uptake (51 studies)
| Thematic area | Examples provided from the studies* | |
| Integration with workflow (38) | Ease of navigation and use (23) | “…88% found the system easy to use…”72 [1990–99, ambulatory care] |
| “…the need to be able to ‘backtrack’ when navigating through the system… Some specific problems with navigating the system were also highlighted, particularly switching between the display of clinical information for the current cycle and that for previous cycles.”29 [2000–07, ambulatory care] | ||
| “More than half felt that their clerical work was easier…”64 [1990–99, institutional] | ||
| Timing and frequency of prompts (25) | “I'm sorry to say that this software is driving me mad… it's also a nuisance when it comes up when everything has been done… it's so annoying that I always exit, but I would feel less antagonistic if I had some individual control.”62 [2000–07, ambulatory care] | |
| “Now we get alerts when we go to charting, which in my workflow is the last step. It's after the patient's gone…” 23 [2000–07, ambulatory care] | ||
| “Too many messages will lead to them all being ignored.”39 [1990–99, institutional] | ||
| Perception of time (30) | “One of the difficulties in the consultation is the severe time constraints that we have. Our consultations are conducted over 7 to 10 min and in that time we have to cover quite a lot of ground. And if you have to call upon a system that takes another 3 or 4 min, it means surgery is running late.”67 [2000–07, ambulatory care] | |
| “The indiscriminant, excessive generation of clinical alerts by CPOE systems can also slow clinicians as they pause to decipher alerts, deliberate on whether and how to respond, and potentially document reasons for not complying with alerts.”30 [2000–07, institutional] | ||
| “Users were disillusioned by the time wasting necessity to input information already available on the host database, only to lose it again when exiting the Primed system.”40 [1990–99, ambulatory care] | ||
| “68% reported that patient encounters were either the same duration or slightly faster when using the CDSS tool compared to usual practice.”2 [2000–07, ambulatory care] | ||
| Presentation (19) | “…77% of respondents to the questionnaire stated that the overall screen layout was adequate or better and 61% that the amount of information on screen was adequate or better.”69 [1990–99, ambulatory care] | |
| “42% of responding providers thought that the blinking icon was either too unobtrusive or unnoticeable.”65 [1990–99, ambulatory care] | ||
| “It was suggested that it would be helpful if interactions could be graded according to severity.”28 [2000–07, institutional] | ||
| “Alert does not allow for tailoring to providers' individual needs (eg, cannot turn alert function on/off) (24%)”37 [2000–07, ambulatory care, institutional] | ||
| “For serious allergy interactions, it should stop you from prescribing unless you've made a serious effort to override it.”21 [2000–07, ambulatory care] | ||
| “…some users commented that the presentation of information was dense and that some of the text was small.”29 [2000–07, ambulatory care] | ||
| Content (37) | Relevance (sensitivity vs specificity) (24) | “…79% agreed or strongly agreed that the basic HMR recommendations… were appropriate.”65 [1990–99, ambulatory care] |
| “…prescribers found that DDI alerts often provided them with information that they already knew.”42 [2000–07, ambulatory care] | ||
| “…GPs' opinion that the reminder was not suitable to the prescribing situation. Some reminders were valued as extensive and therefore caused disregarding of GPs.”49 [2000–07, ambulatory care] | ||
| “…some clinicians suggested more information on allergy and atopy was desirable.”51 [2000–07, ambulatory care] | ||
| Quality of information (20) | “Concerns over the comprehensiveness, accuracy and evidence base of the information in alerts predominated”21 [2000–07, ambulatory care] | |
| “…clinical content being described as ‘patronizing’. Clinicians were also concerned about the source and strength of the evidence behind the recommendations.”69 [1990–99, ambulatory care] | ||
| “…75% agreed or strongly agreed that Couplers provides high-quality information.”22 [2000–07, ambulatory care] | ||
| “…Here is updated and systematized information: first a question, then and answer in full detail based on facts and references, and finally a conclusion.”31 [2000–07, ambulatory care, institutional] | ||
| Type of information (15) | “Safety/drug interaction alerts viewed as most helpful and least annoying.”32 [2000–07, ambulatory care] | |
| “90% thought that additional patient advice leaflets would be of some use or invaluable.”69 [1990–99, ambulatory care] | ||
| Links to supporting information (4) | “Users appreciate the ability to seamlessly link other knowledge resources across the Intranet and Internet from within the application.”44 [2000–07, ambulatory care] | |
| Local constraints (2) | “…there was conflict between what was advocated in the guideline and what was possible to achieve in the service setting.”74 [1990–99, institutional] | |
| “The UK ‘Crystal Byte’ was awkward for a Swiss clinician to adapt to a consulting style, which took a broader view of patient management. All participants shared the view that the core set of guidelines incorporated into decision support software should be GINA international guidelines.”53 [1990–99, ambulatory care, institutional] | ||
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The numbers in brackets represent the number of individual studies addressing a particular thematic area.
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↵* Italics indicate actual responses from study participants, non-italicized responses represent quotes from manuscript authors.
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CDSS, clinical decision support system (as defined by authors); CPOE, computerized provider order entry; DDI, drug–drug interactions; GP, general practitioner; HMR, health maintenance reminder.
