Pediatricians' Understanding and Experiences of an Electronic Clinical-Decision-Support-System

Subsequent dosing errors after implementing an Electronic Medical Record (EMR) at a pediatric hospital in Sweden led to the development, in close collaboration with the clinical profession, of a Clinical Decision Support System (CDSS) with Dose Range Check and Weight Based Dose Calculation integrated directly in the EMR. The aim of this study was to explore the understanding and experiences of the CDSS among Swedish pediatricians after one year of practice.

Semi-structured interviews with physicians at different levels of the health care system were performed with seventeen pediatricians working at three different pediatrics wards in Stockholm County Council. The interviews were analysed with a thematic analysis without pre-determined categories.

Six categories and fourteen subcategories emerged from the analysis. The categories included the use, the benefit, the confidence, the situations of disregards, the misgivings/risks and finally the development potential of the implemented CDSS with Weight Based Dose Calculation and Dose Range Check.

A need for CDSS in the prescribing for children is evident to support the prevention of medication errors. After implementing a CDSS, organized efforts are crucial to understand the need for further development based on the practical knowledge of the clinical profession. Different contextual settings of health care organisations do affect the way how physicians think and act in work. When implementing a CDSS in practice we need to describe and analyse the context where the CDSS should be used as well as the prescribers' needs in work.