Development and Implementation of Computerized Clinical Guidelines: Barriers and Solutions

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Research indicates that CDS can improve both clinical performance and patient outcomes. The success of a CDSS depends on the computer system’s ability to be integrated into a complex organizational environment addressing both human and technical issues. The article reviews what is known about physician acceptance of CDS tools and the importance of the physician’s role in development and implementation of the software. The resulting collaboration between clinical and technological experts is likely to improve the use of these clinical tools. [1]

Barriers to Implementation of Clinical Practice Guidelines in a Computerized Format

  • Human factors- Physician knowledge of and experience with computers influences their perception of the usefulness of a CDSS. Lack of confidence toward an information system (IS) arises when a physician is introduced to the system without sufficient or complete information or when a physician encounters problems in trying to use a new IS.
  • Organizational factors- implementation plan must take into consideration the climate and culture of the organization, its readiness and ability to change and manage any disruption in established or traditional practice patterns. Organizations should provide physicians additional time and support to facilitate structured data entry that improves quality and enhances effective clinical operations.
  • Technical factors- Technical issues arise with the workflow changes that incur or when tailoring applications to local and individual workflow. Technical deficiencies can result in loss of confidence in the system or in frustration.


Questionnaires were given to each physician immediately after training and then periodically. The purpose of our questionnaires was to assess end user satisfaction and target any specific barriers or problems. Scores less than 5 were noted by the development and implementation team.


Compliance with questionnaire completion was 100%. All ratings were above the mid-point on the scales indicating a positive response to the software. The scores improved the longer the physicians used the system. The open-ended narrative part of the questionnaires provided suggestions on how to best set up the system for physician permanent use, the usefulness of the application in educating and informing patients an how to improve the applications override system.


For the successful implementation and management of a clinical information system, it is important to measure physician satisfaction and incorporate the feedback into the software program during the process. The implementation phase must be a dynamic process which involves two way communication between developers and end-users.

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  1. Development and Implementation of Computerized Clinical Guidelines:Barriers and Solutions