Opportunities and Challenges Associated with the Pilot Implementation of Clinical Decision Support Systems in a Rural...

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Human-Computer Interaction in Healthcare

Background:

• Clinical Decision Support (CDS) systems are underutilized due to poor alignment with clinician needs.
• Pilot implementations offer a pathway to refine CDS systems by involving users in real-world testing.
• Limited evidence exists on factors contributing to the success of CDS pilot implementations.

Purpose of the Study:

• To explore opportunities and challenges in piloting a CDS system.
• To understand factors influencing the progression of a CDS pilot from implementation to full-scale use.

Main Methods:

• Qualitative study involving semi-structured interviews with clinicians, managers, and vendors.
• Utilized the Non-adoption, Abandonment, Sustainability, Scale-up, and Spread (NASSS) framework.
• Thematic analysis of interviews from a rural Australian hospital's Emergency and Patient Flow departments.

Main Results:

• Key themes included system performance, implementation processes, organizational support, and perceived benefits.
• User input improved CDS design, especially in the Emergency Department, where clinicians were engaged.
• Technical issues and unresolved critical problems due to resource constraints hindered user re-engagement and clinical utility.

Conclusions:

• Successful CDS pilots necessitate organizational and user readiness for engagement and feedback.
• Pilots should be conducted in environments with engaged users and adequate resources to address emerging issues.
• Organizational capacity and user willingness are crucial for effective iterative feedback and CDS system refinement.