Collective agency in the implementation of computerized clinical decision support: an interpretive description study

Area of Science:

• Health Informatics
• Implementation Science
• Health Services Research

Background:

• Digital health interventions like computerized clinical decision support systems (CDSSs) face challenges in real-world clinical practice.
• Barriers include resource limitations, workflow disruptions, and insufficient user engagement.
• Understanding how professionals overcome these implementation hurdles is crucial.

Purpose of the Study:

• To explore the integration of CDSSs into routine clinical workflows.
• To identify contextual factors influencing the successful translation of CDSS implementation knowledge into practice.

Main Methods:

• Interpretive description methodology was employed.
• Semi-structured interviews with 32 participants and focus groups with 11 participants were conducted.
• Participants were experts in health informatics, implementation science, and health services research.

Main Results:

• CDSS implementation is a socio-technical process driven by collective agency.
• Success factors include building trust, fostering collaboration, and achieving shared understanding.
• Key strategies involve engaging stakeholders, creating accessible tools, and strengthening clinical-academic partnerships.

Conclusions:

• Opportunities exist for developing user-friendly tools and robust partnerships.
• Embedding practical, experiential knowledge is vital for successful CDSS adoption.
• Recommendations include establishing feedback mechanisms, formal agreements, and implementation checklists.