Why provision of clinical decision support (CDS) is not enough? Factors influencing the CDS adoption

Abstract

Clinical decision support (CDS) can improve the quality and efficiency of care by increasing access to evidence-based data at the point-of-care. However, CDS adoption is limited in clinical settings. The focus on the technical design have overlooked end-users’ perceptions, social and organisational factors that may influence uptake. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) model, we aimed to identify different challenges and opportunities for CDSS adoption in clinical settings. A cross-sectional online survey was conducted from June-October 2019 with general practitioners, physicians and surgeons in Australia. To measure the impact of UTAUT moderators (age, gender and experience) and care settings (primary care vs. hospitals) on perceived barriers and facilitators to CDS implementation, multivariate logistic regression was carried out. Qualitative data was thematically analysed for emerging patterns and themes. Many respondents indicated that CDS can promote evidence-based care (79%) and improve quality and safety (52%). Overall CDS adoption is dependent on factors such as effort expectancy (ease of use), performance expectancy and a facilitating environment for system use. Clinician perceptions of barriers and facilitators to uptake are associated with type of care setting. There was higher likelihood of perceiving ease of use (OR 1.39, 95% CI 1.15-2.07), time limitations (OR 1.95, 95%CI 1.10-3.77), patient' preferences (OR 2.17, 95% CI 1.14-3.37) and threat to professional autonomy (OR 2.15, 95%CI 1.39-3.41) as factors that influence adoption in primary care. Providing relevant information in right format at right time is critical for successful CDS use. CDS implementation requires a holistic approach addressing users' perceptions and preferences determined through stakeholder consultation. The system design must be easy to use but also facilitated through the provision of on-site training and support. CDS adoption is determined by systems’ ease of use and provision of enabling environment. Users and setting characteristics are important moderators and must be considered in CDS implementation.