Table 1 CDSS uptake features
CDSS context | |
1. Was there a formal process to identify barriers and enablers to current behaviour prior to the CDSS study? e.g. mapping barriers and enablers to intervention components | |
2. Was there a previous study using a CDSS targeting the same primary outcome as the current study, and was that outcome significantly improved by CDSS? | |
3. Is there a gap between the desired and the baseline clinical behaviour identified by study authors? | |
4. Has the availability and quality of the patient data needed to inform the CDSS been formally evaluated? e.g. chart review, validation of patient-facing electronic questionnaires | |
5. Does use of the CDSS enable improvement of the quality of patient data compared to current standard of care? e.g. electronic collection of data, including patient-reported outcomes | |
6. Was there a formal pre-study evaluation of user perceptions that assessed informational needs and/or perceived benefit to using CDSS, and if so, was it positive? | |
7. Was specific additional hardware (other than what was already present as part of usual care) required and available for the CDSS? | |
8. Does the use of CDSS negatively impact the function of existing information systems? e.g. causing new technical issues or slower electronic health record function | |
9. Was a formal workflow analysis conducted prior to formalization of the intervention and did it demonstrate intervention feasibility? | |
10. If a workflow analysis was performed, did it demonstrate that baseline workflow would allow the introduction of the CDSS? | |
CDSS content | |
11. Are developers from an academic centre and report no significant conflict of interest? | |
12. Is the CDSS advice based on disease-specific guidelines? | |
13. Does the CDSS present its reasoning and/or cite research evidence to the user at the time of advice? | |
14. Does the CDSS present the harms/benefits of provided guidance? | |
15. Was the CDSS pilot tested and was the accuracy of information specifically assessed? | |
16. Was there a post-study evaluation of users and were their information needs addressed? | |
17. Does the CDSS clearly explain/indicate why it was triggered for specific patients/situations? | |
18. Was there a pre- or post-study evaluation of users and was CDSS information/advice clear? | |
19. Is the CDSS advice available in the location and software system in which it will be implemented? | |
20. Does the CDSS advice contradict any current guidelines? | |
21. Were there any issues with the amount of decision support delivered if the CDSS was pilot tested? | |
CDSS system | |
22. Was there a formal usability evaluation performed for the CDSS and was it found to be usable? | |
23. Was there a pre- or post-study evaluation of users and was workflow facilitation found to be positive? | |
24. Can the system be customized to provide improved user functionality? | |
25. Is the system always up and running? | |
26. Was there a pre- or post-study evaluation of users and was the advice delivery format found to be appropriate? | |
27. Was there a pre- or post-study evaluation of users and was the visual display/graphic design of CDSS advice found to be appropriate? | |
28. If the CDSS used specific functions for prioritized decision support (i.e. pop-ups), were they pilot tested or assessed in a post-study evaluation? | |
29. Does the CDSS provide advice directly to users who will be making the relevant clinical decisions? | |
30. Does CDSS facilitate collaboration between healthcare providers? | |
31. Does the CDSS provide advice at the moment and point-of-need? | |
CDSS implementation | |
32. Was information about the CDSS available to users (i.e. practical instructions)? | |
33. Are dedicated personnel and/or web- or paper-based resources available to CDSS users for technical support (i.e. help desk, tech support)? | |
34. Was user training provided for the CDSS? | |
35. Were other barriers to the behaviour changes being targeted by the CDSS discussed (i.e. medication costs), and if so were strategies implemented to address those barriers? | |
36. Was CDSS implemented in temporal steps? | |
37. Was CDSS usage and performance evaluated during the study? | |
38. If CDSS usage and performance was monitored during the study, were there strategies in place to fix any identified problems? | |
39. Were local users consulted during the intervention planning or implementation? | |
40. Was there discussion of an overall strategy (i.e. Knowledge Translation strategy) to guide the CDSS initiative? | |
Additional factors from Roshanov et al. | |
41. Was the CDSS developer involved in authorship of the study? | |
42. Was CDSS advice provided automatically in the practitioner’s workflow? | |
43. Did the CDSS provide advice for patients (i.e. educational material)? | |
44. Did the CDSS require a reason for override of use/recommendations? | |
45. Does the CDSS have a critiquing function for actions? (i.e. it activates after orders are entered, suggesting they should be cancelled or revised) | |
46. Does the practitioner have to enter data directly into the CDSS? | |
47. Does the CDSS provide advice or reminders directly to patients (i.e. independent of the clinician)? | |
48. Was the CDSS a commercial product? | |
49. Did practitioners receive advice directly through an electronic interface? | |
50. Did the CDSS target healthcare practitioners other than physicians? | |
51. Was periodic performance feedback provided in addition to patient-specific system advice? | |
52. Was there a co-intervention in the CDSS group? |