Table 2 Summary of CDSS implementation factors

Technological (n = 532)

System fits into existing clinical workflow and organizational structures (n = 67)

[3, 5, 8, 9, 12, 24, 30, 34, 35, 68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125]

Functionalities meeting users’ needs, incl. display of relevant information, customization (n = 58)

[8,9,10, 24, 35, 68,69,70,71, 74, 75, 77, 84, 86, 90,91,92,93, 95,96,97,98,99, 101,102,103,104, 106, 109,110,111,112, 114,115,116, 119,120,121,122, 124, 126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143]

Design of interface and workflow, intuitive navigation (n = 49)

[11, 34, 35, 68, 71, 72, 74, 77, 78, 80, 84, 90, 93, 95, 97, 98, 101,102,103, 106, 107, 110,111,112,113,114, 117, 121, 122, 126, 127, 131, 132, 134,135,136, 138, 141, 142, 144,145,146,147,148,149,150,151,152,153]

System’s technical quality and scientific evidence, incl. explainability and transparency of decision outcomes ( n  = 43) 

[8,9,10,11,12, 68,69,70, 72, 76, 80, 83, 84, 87, 88, 90, 91, 93, 100, 106, 107, 111, 114, 121, 134, 141, 142, 147,148,149, 151, 152, 154,155,156,157,158,159,160]

Ease of use ( n  = 39)

[9, 10, 17, 24, 30, 34, 68, 69, 71, 73, 74, 76,77,78, 86, 87, 90, 91, 93, 96, 104, 106, 107, 110, 111, 115, 120, 127, 129, 136, 141, 147, 150, 151, 154, 160,161,162,163,164,165,166]

Irrelevant, inaccurate, excessive alerts (n = 36)

[9, 11, 24, 35, 68, 69, 72, 74,75,76, 90, 91, 96, 98, 101, 103,104,105,106, 111, 112, 114, 118, 120, 122, 127, 129,130,131, 136,137,138, 144, 164, 167, 168]

Usefulness of system features and functions, incl. practical guidance and functions meeting complexity of patients’ clinical picture (n = 32)

[10, 12, 17, 24, 35, 68, 76, 80, 84, 86, 91, 93,94,95, 101, 104, 106, 110, 112, 115, 132, 140, 144, 145, 148, 160, 162, 169,170,171,172,173]

Robust and reliable system (n = 30)

[10, 11, 24, 35, 68, 72,73,74, 84, 86, 88,89,90, 93, 106, 114, 119, 120, 123, 127, 132, 137, 138, 144, 147, 149, 154, 163, 164, 166]

System interoperability (n = 30)

[10, 30, 35, 68, 71, 75, 78, 93, 94, 96, 100, 102, 104, 112, 114, 115, 119, 124, 126, 127, 131, 134, 137,138,139, 151,152,153,154, 163]

Technical, IT support (n = 30)

[3, 8, 10, 11, 17, 68, 69, 77, 79, 84, 85, 89, 95, 99,100,101, 104, 116, 117, 139, 143, 144, 146, 147, 153, 163, 167, 170, 171, 174]

Timely and fast access to relevant information, functions (n = 26)

[9,10,11, 35, 68, 69, 73, 77, 78, 95, 96, 106, 111, 114,115,116, 122, 131, 135, 137, 140, 144, 147, 150, 163]

Data privacy and security issues (n = 22)

[3, 11, 12, 34, 68, 69, 73, 75, 84, 85, 88, 89, 101, 106, 127, 131, 138,139,140, 163, 175, 176]

Data quality, standards, and terminologies (n = 22)

[34, 68, 72, 74, 77, 93, 94, 96, 101, 103, 108, 110, 120, 140, 146, 153, 161, 163,164,165,166, 177]

Rigidity of system (functional and interface) (n = 17)

[10, 11, 34, 69, 74, 79, 84, 93, 94, 109, 114, 132, 135, 144, 147, 168, 170]

Value, benefit to end users (n = 16)

[9, 79,80,81, 84, 86, 89, 103, 121, 132, 148, 162, 168, 170, 175, 178]

Efficiency and time saving potential (n = 15)

[10,11,12, 89, 95, 96, 106, 111, 114, 121, 137, 140, 144, 147, 164]

Organizational (n = 287)

Work, time pressure and tension (n = 52)

[8, 9, 11, 30, 35, 68, 69, 72, 74,75,76,77, 79, 82, 84, 87, 88, 90, 91, 93, 95,96,97,98,99, 101, 102, 104, 106, 110, 111, 114, 115, 118, 121,122,123, 126, 127, 133, 134, 138, 144, 145, 150,151,152,153, 155, 162, 169, 171]

User training and supervision ( n  = 48)

[3, 5, 8, 10, 11, 24, 48, 69, 75,76,77, 79, 83, 84, 86, 88, 92, 97, 101, 103, 104, 107, 110, 115, 124, 129, 130, 135, 139, 144,145,146, 150,151,152, 154, 155, 165,166,167, 171, 174, 175, 178, 179]

Internal communication, feedback, collaboration, involvement of end users ( n  = 45)

[8, 11, 12, 30, 34, 68,69,70, 72, 74, 76, 79, 80, 82,83,84, 87, 88, 92, 101, 103,104,105, 109,110,111,112, 115, 116, 118, 121, 122, 129, 131, 134, 139, 140, 143,144,145, 150, 163, 167, 169, 174, 178, 180, 181]

Endorsement, support of management, leadership for change (n = 33)

[10, 11, 24, 68,69,70, 72, 76, 79, 82,83,84,85, 92, 94, 100, 104, 115, 116, 126, 129, 143,144,145,146, 152, 153, 167, 169, 172, 174, 175, 178]

Readiness of internal IT infrastructure and hardware (n = 32)

[8, 10, 11, 17, 68, 79, 80, 82,83,84,85,86, 88, 95, 109, 110, 134, 139, 141, 144, 146, 147, 151, 154, 155, 170, 171, 175, 179,180,181,182]

Internal (re)organization, change of routines, incl. standardization of processes (n = 21)

[24, 70, 75,76,77, 82, 84, 86, 112, 117, 137, 141, 151, 152, 170, 171, 174, 175, 179, 180]

Organizational culture, innovation climate and policies, incl. psychological safety (n = 20)

[9, 10, 12, 68, 72, 76, 81, 86, 94, 115, 118, 124, 131, 139, 151, 153, 165,166,167,168, 174]

Internal IT competencies and knowledge (n = 13)

[72, 74, 83, 84, 91, 93, 121, 123, 126, 143, 155, 166, 174]

Financial and legal issues (n = 13)

[24, 68,69,70, 77, 112, 117, 118, 128, 151,152,153]

Hierarchical boundaries (n = 10)

[24, 69, 70, 77, 112, 117, 128, 151,152,153]

Human (n = 197)

Individual attitudes and emotional responses, incl. resistance to change (n = 41)

[3, 5, 10,11,12, 17, 24, 35, 68, 77, 81,82,83,84, 86,87,88,89, 105, 111, 117, 121, 132, 145, 146, 151,152,153,154, 160, 162, 163, 167, 169, 170, 172, 175, 178, 180, 183, 184]

Experience and familiarity with system (n = 35)

[3, 5, 10, 24, 48, 69, 79, 82, 87,88,89, 98, 104, 105, 108, 111, 114, 127, 131, 133, 135, 138, 139, 144, 147, 154, 158, 168, 170, 178, 182, 183, 185,186,187]

Trust in system and underlying rule or algorithm (n = 31)

[11, 12, 24, 35, 69, 73, 74, 77, 78, 94, 95, 104, 105, 109, 119, 120, 127, 128, 132, 133, 137, 144, 146, 151, 154, 162, 164, 177, 178, 180, 185]

Computer illiteracy, IT skills (n = 23)

[5, 8, 10,11,12, 35, 73, 82,83,84, 89, 90, 100, 120, 143, 145, 152, 160, 177, 181, 183, 188]

Perceived usefulness (n = 22)

[5, 70, 73, 90, 94, 101, 104, 109, 112, 113, 115, 116, 128, 133, 135, 136, 154, 157, 164, 165, 181, 185]

Perceived potential of patient education and empowerment ( n  = 13)

[83, 84, 96, 114, 144, 152, 158, 159, 169, 178, 182, 183]

Intrinsic motivation, passion, expected effort (n = 12)

[30, 73, 75, 93, 101, 104, 109, 110, 115, 134, 140, 151, 161]

Clinical knowledge and skills (n = 10)

[8, 74, 77, 94, 119, 137, 152, 160, 177, 185]

Perceived potential of training, education of clinicians by system (n = 10)

[12, 17, 70, 89, 101, 104, 132, 137, 162, 178]

Benefits (n = 93)

System improves effectiveness and efficiency of care (n = 34)

[8,9,10,11, 17, 68, 69, 72, 73, 77, 80, 81, 89, 97, 100, 107, 109, 115, 116, 121, 134, 135, 141,142,143,144, 147, 148, 152, 154, 155, 158, 160, 182]

System is beneficial to patient safety (n = 25)

[8, 10, 11, 17, 24, 69, 74, 80, 81, 89, 91, 94, 96, 102, 104, 106, 121, 126, 137, 144, 152, 154, 159, 175, 178]

System improves quality of care (n = 21)

[8,9,10,11, 35, 69, 70, 76, 81, 98, 101, 133, 141, 147, 148, 151, 154, 160,161,162, 164]

System prevents prescription and treatment errors (n = 13)

[8, 11, 24, 69, 77, 80, 102, 107, 134, 136, 144, 154, 169]

Professional identity threat (n = 90)

Perceived threat to professional control, autonomy, responsibilities, role (n = 58)

[5, 9, 10, 12, 17, 24, 30, 34, 48, 68, 69, 72, 73, 75, 77, 80,81,82, 84, 86, 89, 91,92,93,94, 97, 98, 102,103,104, 112,113,114, 116, 120, 121, 126, 128, 129, 131, 132, 134, 137, 140, 144,145,146, 154, 155, 162,163,164,165, 167, 175, 177, 178, 180]

Perceived loss of control over patient relationship (n = 17)

[12, 35, 73, 81, 89, 93, 101, 104, 111, 114, 115, 129, 136, 137, 140, 162, 170]

Perceived threat to clinical skill and expertise, incl. risk of overdependence (n = 15)

[24, 30, 72, 73, 91, 92, 96, 102, 104, 114, 120, 137, 154, 164, 167]

Professional identity enhancement (n = 44)

Perceived enhancement of control of patient relationship, incl. beneficial for patient-provider communication (n = 18)

[17, 35, 68, 74, 75, 89, 93,94,95, 109, 132,133,134, 140, 141]

Perceived enhancement of professional control and autonomy, responsibilities, role (n = 15)

[24, 34, 35, 72, 91, 92, 104, 115, 137, 155, 161, 169, 178, 180]

Perceived enhancement of clinical skill and expertise (n = 11)

[8, 12, 78, 92, 101, 128, 133, 140, 155, 162, 178]