Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research

Introduction

Clinical decision support systems (CDSS) are integrated into electronic health records and intended to influence clinical decisions and improve quality of care processes. Evidence has shown improved clinical performance yet the improved health care quality and improved outcomes have been mixed.

Interesting research question

What are the possible reasons and causes from healthcare clinicians’ perspectives for difficulties in integrating CDSS?

Methods

The authors did a meta-synthesis associated with CDSS integration using research studies from actual CDSS clinical settings. They conducted a literature search using key words “CDSS in healthcare” and “clinicians experience of CDSS adoption”. PubMed and CINAHL databases were searched. Only peer reviewed journal articles from years 2000-2013 were selected. From the results, the bibliographies were reviewed for any additional relevant studies.

Results

PubMed returned 3797 studies and CINAHL returned 361 studies for a total of 4158. Selecting only those studies that met criteria further narrowed the results. In total 81 studies were used.

Conclusions

Overall, there was a lack of quality studies that addressed the clinicians experience with CDSS and overall studies with limited understanding of the clinicians’ workflow. CDSS provided alerts and reminders based on well-defined objectives yet provided little natural decision support or situational awareness. Five areas identified which needed further study. They were usability, clinician-patient-system integration, algorithm immaturity, and system immaturity.

Area of interest

The human-computer interactions and the need to better understand the relationship between computational and human reasoning and problem solving.