A survey of factors affecting clinician acceptance of clinical decision support

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This is a review of Sittig, D.F., Krall, M.A., Dykstra, R.H., Russell, A. and Chin, H.L. (2006). “A survey of factors affecting clinician acceptance of clinical decision support”. [1]


Sittig et al., (2006) recognized that despite the promising evidence that clinical decision support (CDS) can lower cost, improve patient care and affect patient safety there has been slower adoption rates of CDS systems than would have been predicted. There are examples of literature to be found that does not show any improvement in clinical outcomes even with CDS employed, such a paper is titled Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury – a randomized, controlled trial. Sittig et al., (2006) “hypothesized that factors affecting CDS system acceptance could be categorized as relating to differences in patients, physicians, CDS-type, or environmental characteristics” (p.1 of 7).


Sittig et al., (2006) surveyed all adult primary care physicians at a Health Maintenance Organization (HMO) in an attempt to isolate features that influence how they feel about the particular CDS. Sittig et al., (2006) defined CDS as "clinical information that is either provided to you or accessible by you, from the EpicCare clinical workstation" (p.3 of 7). The researchers sent out a two page anonymous survey via interdepartmental mail to all Internal Medicine and Family Medicine physicians who numbered two hundred and twenty-five. Respondents sent in their completed surveys over a five week period and no interventions were used in an attempt to increase the return rate of completed surveys.


Sittig et al., (2006) reported in their findings that “there was no difference in clinicians' response to the question of how often they accept each of the three different types of clinical decision support alerts cost-related; safety-related; health maintenance” (p.4 of 7). Interesting results that were found included that physicians were more likely to accept alerts on elderly patients, patients taking multiple medications and patients having several comorbidities. Sittig et al., (2006) also found that clinicians also communicated that they were much less likely to accept alerts if they were behind schedule. Physicians were more likely to find CDS beneficial when it was integrated into the clinical workstation and was present as part of the clinical workflow e.g. in the examination room. They report favorably towards the alert reminders that were generated by the CDS and were more likely to act on them when presented in this manner.


Sittig et al., (2006) concluded that “Based on the results of this survey we believe that patient and environmental characteristics are among the most important factors affecting the stated acceptance of various clinical decision support suggestions” (p.6 of 7). The authors did not find any supporting evidence that clinician demographics such as years of experience, age or gender had any influence on alert acceptance rates. Sittig et al., (2006) recommends further research to be done on their finding of how clinicians ignore CDS alerts when running behind schedule. Particularly since physicians also communicated they find benefit to the CDS software provided.

This was a very interesting read and a most important area of CDS research: to attempt to make CDS alerts more widely accepted and beneficial to clinicians and patients alike. Future research on this topic will no doubt greatly improve the efficacy of CDS alerts.


  1. Sittig, D.F., Krall, M.A., Dykstra, R.H., Russell, A. and Chin, H.L. (2006). A survey of factors affecting clinician acceptance of clinical decision support. BMC Medical Informatics and Decision Making; 6:6. doi:10.1186/1472-6947-6-6