Implementation of multiple-domain covering computerized decision support systems in primary care: a focus group study on perceived barriers

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Clinical decision support systems (CDSS) are becoming widespread in use in different healthcare settings. However, confirmation that shows the actual usage of the systems is still hard to come by. This particular study aims to find out what kind of obstacles keep the CDSSs from being used, particularly by primary care practitioners.


The study took place in the Netherlands. The CDSS that was involved is called NHGDoc; it “provides GPs, GP trainees and PNs evidence-based and, on the basis of structured data in the EHRS (also known as Electronic Medical Records (EMR)), patient-specific advices during consultation in terms of patient data registration, drug prescription and management.”[1] The study design used was qualitative that used three focus groups.[1] The focus group involved a discussion about “perceived barriers” that the members could name.[1]


From the barriers mentioned, three different types emerged: knowledge-related barriers, barriers related to the evaluation of the features of the CDSS (source and content, format/lay out, and functionality), and external barriers interacting with the CDSS (patient-related and environmental factors).[1] Within the knowledge-related barriers, the main concern was due to not understanding features of the CDSS. Within the evaluation of the features of the CDSS, three concerns were mentioned:

  • the source and content of the CDSS
  • the format or lay out of the CDSS content
  • the functionality of the CDSS.[1]

Within the external barriers interacting with the CDSS, two concerns were mentioned: patient-related factors and environmental factors.[1]


The presence of a multitude of barriers highlights a key component to low usage of CDSS by providers. With knowledge being a component of the barriers, good introductions to the CDSS is key. However, a key limitation of the study is the small sample size.


The study provides a good survey into what kind of barriers are perceived by the minds of the providers. Even with the limitations of the study, the barriers found can be used as a guide to ask other providers about what barriers may be present; this also helps with future studies as well, acting as a guide for understanding and finding barriers.

Related Articles

Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study

What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 Lugtenberg, M., Weenink, J.-W., van der Weijden, T., Westert, G. P., & Kool, R. B. (2015). Implementation of multiple-domain covering computerized decision support systems in primary care: a focus group study on perceived barriers. BMC Medical Informatics & Decision Making, 15(82).