Interorganizational Mechanisms for Developing and Implementing Clinical Decision Support Systems in Primary Care:...

Area of Science:

• Health Services Research
• Information Systems in Healthcare
• Primary Care Management

Background:

• Clinical decision support systems (CDSS) offer potential for enhancing patient safety and reducing costs in primary care.
• Limited adoption of CDSS stems from development and implementation challenges within complex primary care settings.
• Existing frameworks for complex interventions offer limited guidance on interorganizational collaboration processes for CDSS implementation.

Purpose of the Study:

• To examine how an interorganizational collaboration in Dutch primary care (GzGr) achieved iterative CDSS development and implementation.
• To identify mechanisms supporting collaboration in overcoming CDSS development and implementation challenges.

Main Methods:

• An exploratory process-level case study was conducted.
• Data collection involved 15 semistructured interviews, triangulated with documents and expert input.
• A thematic, inductive approach was used to develop a chronological overview and identify key mechanisms.

Main Results:

• Two primary mechanisms were identified: enacting an interorganizational value model and iterative, co-creative experimentation.
• The value model involved a coalition of the willing with shared goals, prioritizing collective benefit and guiding development choices.
• Iterative experimentation facilitated rapid feedback, validation, and continuous refinement involving multistakeholders.

Conclusions:

• The identified mechanisms sustained interorganizational collaboration and CDSS development by linking collaborative and technical changes across multiple levels.
• These mechanisms enabled technological viability, stakeholder value, and multilevel support through iterative cycles.
• Practical implications include engaging diverse stakeholders, using an orchestrating actor, and adopting an iterative development-implementation approach.