Using normalisation process theory to understand workflow implications of decision support implementation across...

Area of Science:

• Health Informatics
• Clinical Workflow Optimization
• Implementation Science

Background:

• Integrating new technologies into clinical workflows is challenging due to poor daily activity integration.
• Normalisation Process Theory (NPT) offers a framework to understand the 'work' required for implementing complex practices.
• Assessing facilitators and barriers for clinical decision support (CDS) tools is crucial for effective adoption.

Purpose of the Study:

• To determine the suitability of NPT for assessing implementation barriers of CDS tools.
• To evaluate the 'work' involved in implementing two CDS tools across different care settings.
• To longitudinally assess the implementation of new CDS tools using NPT.

Main Methods:

• Quantitative surveys adapted from the NPT toolkit were administered at baseline and 6 months.
• Surveys assessed four NPT domains: sense-making, participation, action, and monitoring.
• Data were collected from clinic leadership at two academic primary care institutions (n=60).

Main Results:

• NPT domain scores were consistent across roles and institutions at baseline.
• A significant decrease in NPT domain scores was observed at the 6-month follow-up.
• Declines were noted in specific domains for clinic managers and medical directors, and across all domains for certain institutional sites.

Conclusions:

• NPT effectively assessed longitudinal implementation barriers for new CDS tools.
• Consistent results across roles highlight shared implementation 'work'.
• The decline in engagement suggests a need for sustained contact to maintain implementation momentum and improve EHR technology success.