Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study

Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues, overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake across different stages of implementation. We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline physicians, nurses, information technology staff, and members of the hospital board of directors. We will use semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until no new information is gained from the interviews. CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be considered when planning their introduction in healthcare settings. The findings of this study will guide the development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake will better capture the complexity of roles and contextual factors affecting CDSS uptake

Barriere e facilitatori all'implementazione dei sistemi di supporto decisionale computerizzati in ospedale: Uno studio "grounded theory"

Introduction: Computerized Decision Support Systems (CDSSs) connect health care professionals with high-quality, evidence-based information at the point-ofcare to guide clinical decision-making. Current research shows the potential of CDSSs to improve the efficiency and quality of patient care. The mere provision of the technology, however, does not guarantee its uptake.This qualitative study aims to explore the barriers and facilitators to the use of CDSSs as identified by health providers. Methods: The study was performed in three Italian hospitals, each characterized by a different level of familiarity with the CDSS technology. We interviewed frontline physicians, nurses, information technology staff, and members of the hospital board of directors (n=24). A grounded theory approach informed our sampling criteria as well as the data collection and analysis. Results: The adoption of CDSSs by health care professionals can be represented as a process that consists of six "positionings," each corresponding to an individual's use and perceived mastery of the technology. In conditions of low mastery, the CDSS is perceived as an object of threat, an unfamiliar tool that is difficult to control. On the other hand, individuals in conditions of high mastery view the CDSS as a helpful tool that can be locally adapted and integrated with clinicians' competences to fulfil their needs. In the frst positionings, the uptake of CDSSs is hindered by representational obstacles. The last positionings, alternatively, featured technical obstacles to CDSS uptake. Discussion: Our model of CDSS adoption can guide hospital administrators interested in the future integration of CDSSs to evaluate their organizational contexts, identify potential challenges to the implementation of the technology, and develop an effective strategy to address them. Our findings also allow reflections concerning the misalignment between most Italian hospitals and the current innovation trends toward the uptake of computerized decision support technologies.Introduzione. I sistemi di supporto decisionale computerizzati (SSDC) collegano le informazioni specifiche di ogni paziente alle evidenze scientifiche disponibili in selezionate banche dati, offrendo un immediato supporto ai clinici durante i processi decisionali. Diversi studi suggeriscono che i SSDC hanno la potenzialit\ue0 di migliorare l\u2019efficienza e la qualit\ue0 delle cure. Tuttavia, la loro disponibilit\ue0 nei contesti di cura non ne garantisce l\u2019adozione in pratica. Il presente studio qualitativo \ue8 finalizzato a esplorare le barriere e i facilitatori all\u2019adozione dei SSDC cos\uec come percepiti dal personale ospedaliero chiamato a farne uso. Metodi. I dati empirici sono stati raccolti attraverso interviste qualitative semi-strutturate, condotte e analizzate secondo il metodo grounded theory. La rilevazione ha coinvolto tre ospedali del Nord Italia, caratterizzati da diversi livelli di familiarit\ue0 con i SSDC. Le interviste (n=24) sono state sottoposte a diverse figure professionali: medici, infermieri, membri dello staff IT (Information Technology) e membri delle direzioni ospedaliere. Risultati. L\u2019adozione dei SSDC si configura come processo articolato in sei \u201cposizionamenti\u201d, che rappresentano sei possibili esperienze di utilizzo dei SSDC: a un estremo, il sistema \ue8 percepito come un oggetto minaccioso e incontrollabile e, all\u2019estremo opposto, come uno strumento a servizio dei clinici. I primi posizionamenti sono connotati da ostacoli rappresentazionali mentre i posizionamenti pi\uf9 vicini all\u2019utilizzo sono connotati da gli ostacoli tecnici . Discussione. Il modello consente a decisori e manager di collocare i propri contesti di riferimento in uno (o pi\uf9) dei posizionamenti descritti, \u201cdiagnosticando\u201d cos\uec il rispettivo livello di maturit\ue0 nei confronti dei SSDC e identificando le leve su cui agire per avvicinarsi a un\u2019integrazione soddisfacente dei SSDC. I risultati sono discussi anche alla luce degli attuali trend innovativi in sanit\ue0, consentendo alcune riflessioni riguardo allo status quo e al potenziale di sviluppo degli ospedali italiani