Factors Influencing the Implementation and Distribution of Clinical Decision Support Systems (CDSS)

Clinical Decision Support Systems (CDSS) can have positive effects on quality of care measures, yet have not gained widespread traction in healthcare. This study sought to determine and evaluate barriers and facilitators to CDSS implementation and distribution. Based on 768 systems identified in a literature review we conducted semi-structured telephone interviews with 54 system developers in 16 countries. Qualitative analysis led to the identification of 66 key factors influencing implementation. Central issues evolved around CDSS properties, quality and integration, as well as usability, user related factors, internal marketing, resource issues and collaborations with emphasis partly on topics differing from existing research. Additionally, evidence pointed to regional differences regarding implementation hurdles. Recent regulatory requirements were deemed less of a barrier to system adoption than expected, even though lacking expertise in this area was surprisingly common among interview partners.