Table 2 Characteristics of studies included in the scoping review and evidence map
Author, year, and country of study | Study design | Brief study aim, objective, or focus | Description of CDSS implemented | Participants in study |
|---|---|---|---|---|
Barriers and facilitators assessed pre-implementation | ||||
Blanco et al., 2018, USA [35] | Qual | Understand healthcare workers perceptions of barriers and facilitators related to the uptake of computerized tools to reduce Clostridium difficile infection. | EHR-integrated CDSS automatically generates an order for contact precautions when Clostridium difficile testing is ordered. | Nurses, physicians, physician assistants, pharmacists, radiologist technicians, and environmental service workers (n = 47). |
Flynn et al., 2015, UK [36] | Qual | Develop a CDSS to support patient-specific clinical decision-making related to thrombolysis for acute ischaemic stroke and communicate personalized risk information to patients and families. | Computerized decision Aid for Stroke thrombolysis (COMPASS); provides decision support for thrombolysis. | Stroke physicians, ED physicians, and stroke nurse practitioners (n = 31). |
Hasnie et al., 2018, USA [37] | Mixed methods | Develop a CDSS to provide guidance for clinicians at the point of care when treating patients with familial hypercholesterolemia. | Not yet developed. | Specialists including cardiologists, endocrinologists, medical geneticists, and primary care physicians (n = 210 survey, n = 19 focus groups). |
Laka et al., 2021, Australia [7] | Mixed methods | Identify individual, organizational and system-level factors that influence and moderate the adoption, use and perceptions of use of a CDSS for antimicrobial management. | Connects evidence-based information on antibiotic prescribing with patient information to present accurate, real-time information to assist clinical decision-making. | Antibiotic prescribing clinicians in hospitals and primary care (n = 180). |
Melnick et al., 2019, USA [38] | Qual | Describe challenges to implementation and scalability of CDSS for ED-initiated interventions for opioid use disorder. | EHR-integrated web-based CDSS providing optional assessment tools and treatment pathways for initiating buprenorphine treatment in the ED. | ED Physicians (n = 26). |
Mugabe, 2021, New Zealand [39] | Quant | Investigate the barriers, facilitators and likelihood of radiation therapy professionals adopting AI to aid treatment planning. | CDSS not specified; focused on AI and machine learning to improve standards of care, reduce side effects, and enhance quality of life. | Clinicians and specialists involved in radiation treatment (n = 101). |
Ploegmakers et al., 2022, Europe [40] | Quant | Assess barriers and facilitators for CDSS use by physicians treating community-dwelling and hospitalized older patients at risk of falls. | EMR-integrated to support clinicians in medication reviews and deprescribing decisions regarding fall-risk-inducing drugs in older falls patients. | Primary, secondary, and tertiary care physicians, nurse practitioners, and physicians’ assistants across Europe (n = 581). |
Westafer et al., 2020, USA [41] | Qual | Identify barriers and facilitators to the adoption of evidence-based diagnostic testing for Pulmonary Embolism in the ED. | Risk stratification CDSS tool utilizing scores from recognized clinical guidelines. | Physicians from twelve academic and community hospitals (n = 23). |
Yadav et al., 2015, USA [42] | Mixed methods | Use human factors engineering methods to design a more appropriate CDSS for pediatric trauma resuscitations. | Real-time rule-based CDSS based on dichotomous (yes/no) responses to questions entered by the clinician. | Pediatric emergency medicine providers (n = 40), human factors engineers (n = 3), emergency medicine academic faculty members (n = 5). |
Barriers and facilitators assessed during or post-implementation | ||||
Ballard et al., 2016, USA [43] | Quant | Assess clinician adoption of CDSS for site-of-care decision-making for ED patients with acute pulmonary embolism and characteristics associated with increased likelihood of use. | EHR linked assistive CDSS calculates the Pulmonary Embolism Severity Index (PESI) score, and provides PESI stratification data and risk profiles, and a list of additional reasons to consider admission of patients. | ED staff, n not clearly stated. |
Bersani et al., 2020, USA [44] | Mixed methods | Conduct implementation evaluation of CDSS dashboard for patient safety including use, and perceptions of its usability and effectiveness. | Dashboard utilizing real-time EHR data to assist clinicians to quickly assess high-priority safety domains for patients admitted to hospital. | Nursing staff, prescribers, unit leadership, and other staff (n = 413). |
Bowen et al., 2011, Canada [45] | Mixed | Assess effectiveness of incorporating guidelines into a CPOE for pediatric diagnostic imaging, identifying implementation barriers, facilitators and key stakeholders’ perspectives. | Compares diagnostic imaging orders with clinical guidelines and suggests alternative more appropriate order. | Physicians (n = 104). |
Campion et al., 2011, USA [46] | Qual | Highlight barriers and facilitators to CDSS use for intensive insulin therapy by nurses in intensive care units. | A dosing calculation embedded in the CPOE. | Surgical ICU and trauma ICU nurses (49 h of observation). |
Chow et al., 2014, Singapore [47] | Mixed methods | Understand physicians’ perceptions of a hospital’s antibiotic CDSS and the impact of psychosocial factors on acceptance of treatment recommendations. | CDSS integrates AMS with electronic prescribing. | Senior and junior doctors (n = 265 survey, n = 11 focus groups). |
Chua et al., 2018, Singapore [48] | Qual | Explore hospital physicians’ perceptions and attitudes towards antimicrobial stewardship programs and CDSS. | CDSS provides patient-specific evidence-based antibiotic recommendations at the point of prescribing. | Senior and junior hospital physicians (n = 37). |
Chung et al., 2017, USA [49] | Qual | Determine cultural beliefs, barriers and facilitators to implementation of EHR-integrated CDSS for antimicrobial stewardship in the pediatric ED. | Yet to be developed. | Bioinformatics, quality and safety, medical leaders in AMS, pediatric emergency medicine, pediatricians, clinical decision support teams, physician assistants, and nurse practitioners (n = 5 interviews, n = 17 focus groups). |
Collins et al., 2012, Ireland [50] | Mixed | Inform user-centered design of a CDSS for oncology, and understand attitudes and knowledge of physicians and pharmacists about CDSS in oncology. | CDSS makes clinical suggestions based on the information submitted by the user or using evidence-based medicine. | Medical oncologists and oncology pharmacists (n = 41). |
Cresswell et al., 2017, UK [10] | Qual | Explore how healthcare workers and organizations accommodated the introduction of CPOE and CDSS for hospital prescribing over time. | CPOE and CDSS for hospital prescribing which varied in type of system implemented (e.g., stand-alone vs EHR-integrated). | Physicians, nurses, pharmacists, allied health professionals, support staff, implementation managers, technicians, and system vendors across six hospitals (n = 173 interviews, n = 24 observations, n = 17 document audits). |
de Vries et al., 2013, the Netherlands [51] | Quant | Explore perceived barriers and differences of heart failure nurses and cardiologists to using a CDSS for heart failure treatment, and assess relevance and influence of knowledge management. | A specific CDSS in the treatment of heart failure patients but is not described. | Cardiologists and heart failure nurses (n = 162). |
English et al., 2017, USA [52] | Quant | Determine clinical pharmacists’ acceptance of a CDSS for surveillance of pharmaceutical therapies across a health system. | CDSS provides real-time surveillance of pharmaceutical therapies in a dashboard view. Includes rules against medication, laboratory, and demographic patient data. | Clinical pharmacists (n = 25). |
Giuliano et al., 2018, USA [53] | Qual | Explore process of pharmacists using a single CDSS tool to perform antimicrobial stewardship across a healthcare system. | EHR-integrated CDSS identifies patients for prospective evaluation and intervene to improve antimicrobial prescribing. | Hospital-based pharmacists (n = 19). |
Glassman et al., 2002, USA [54] | Quant | Understand benefits and barriers to use of automated, embedded CPOE drug alerts in outpatient care across a Veterans Affairs health care system. | EHR medication ordering program incorporating “critical” or “significant” automated alerts for approximately two thousand specified drug combinations. | Internal medicine (general and subspecialty), neurology, physical medicine, and psychiatry clinicians (n = 168). |
Goud et al., 2010, the Netherlands [55] | Qual | Understand the effect of a CDSS on cognitive, organizational, and environmental barriers and facilitators which may impact cardiac rehabilitation guideline implementation. | Assists needs assessments for cardiac rehabilitation according to Dutch multidisciplinary cardiac rehabilitation guidelines. | Cardiac rehabilitation nurses (n = 29). |
Grau et al., 2019, USA [56] | Qual | Understand barriers and facilitators to physician use of a smoking cessation CDSS and ascertain how to improve its uptake and use. | E-STOPS, an EHR embedded CDSS that alerts physicians of the patient’s smoking status and facilitates selection of evidence-based smoking cessation treatment options. | Physicians and internal medicine residents (n = 21). |
Green et al., 2019, USA [57] | Mixed methods | Understand the factors that may limit use and perceived usefulness of medical calculators (including EHR integration). | Computer software medical calculators input patient supplied and/or clinically sourced data and returns a discrete answer through an equation, a decision tree/questionnaire, or an algorithm. | Physicians (n = 108). |
Gutenstein et al., 2019, New Zealand [58] | Qual | Create a digital clinical pathway for acute chest pain in the ED by combining clinical workflow, decision support, documentation, and research within the EHR. | A digital clinical pathway that acts as a pragmatic guide and a map of clinical workflow that describes the patient journey through a local health system. | Emergency medicine and cardiology physicians (n = 10). |
Jacobs et al., 2014, USA [59] | Mixed methods | Describe current clinical information system functionality for laboratory monitoring of immunosuppressive care, describe guideline use to enable computable logic and alerts to support guideline adherence, and explore CDS implementation barriers in liver transplant centers. | Yet to be developed. | Liver transplant care team members (n = 80). Surveys completed by one or more team members. |
Johnson et al., 2015, UK [60] | Mixed methods | Understand factors influencing feasibility and impact on provider behavior of a CDSS to optimize angina management in chest pain clinics. | Web-based CDSS supports investigation and medication decisions for patients with onset stable chest pain. | Cardiologists, specialist cardiac nurses, physiologists (n = 74); and analysis of 285 patient records. |
Lai et al., 2006, USA [61] | Mixed methods | Understand reasons underlying limited use of acute cardiac ischemia CDSS in ED, and explore potential of computer-based tutorial to overcome barriers to CDSS use. | The Acute Cardiac Ischemia-Time Insensitive Predictive Instrument is printed in real time on the ECG header. | Internal medicine residents (n = 16). |
Lesselroth et al., 2011, USA [62] | Mixed methods | Describe a CDSS intervention to improve adherence of surgeons to DVT prophylaxis recommendations and use sociotechnical theory to identify new system adoption barriers and facilitators. | Provides surgeons with DVT prophylaxis recommendations aligning with clinical guidelines when accessing post-operative order sets. | Surgeons, n not clearly stated. |
Liberati et al., 2017, Italy [12] | Qual | Examine perceived barriers and facilitators to CDSS uptake in hospitals at different stages of CDSS adoption, and construct a framework to guide CDSS implementation. | Commercial CDSS that compiles available evidence for treatment of a wide range of common conditions and provides point of care recommendations. | Doctors, nurses, managers, and IT specialists (n = 30). |
Masterson et al., 2018, USA [63] | Mixed methods | Summarize multicentre PECARN implementation trial findings and reach, adoption, implementation, and maintenance of a EHR-integrated computerized tomography (CT) CDSS in the ED. | EHR based CT CDSS estimates risk of clinically important Traumatic Brain Injury (TBI) indicators and recommends CT based on the PECARN TBI prediction rules. | Physicians, nurses, assistants, and other stakeholders (n = 37). |
Miller et al., 2019, USA [64] | Mixed methods | Describe iterative process of developing a CDSS for adolescent sexual health needs in the ED. | Decision tree facilitated as a branch-logic questionnaire using patient responses to make recommendations. | Clinicians (n = 57) and adolescent patients (n = 57). |
Petitgand et al., 2020, Canada [65] | Qual | Analyze AI-based CDSS implementation in ED focusing on the actors’ representations of the system. | CDSS uses deep learning and natural language processing to triage patients presented to the ED, based on patient responses to adaptive questions. | CDSS developers, academic health center managers, ED physicians, ED nurses (n = 20). |
Salwei et al., 2021, USA [66] | Qual | Study barriers and facilitators to workflow integration of a CDSS in ED of large academic health system. | EHR embedded CDSS combines two risk scoring algorithms recommended to support diagnosis of Pulmonary Embolism. CDSS populates data from the EHR to calculate the patient’s risk score, provides a recommendation for the next step, supports ordering the diagnostic test, and documents the decision and order in the physician’s note. | Physicians (n = 12). |
Santucci et al., 2016, Australia [67] | Qual | Determine uptake and perceived usefulness of CDSS embedded in electronic prescribing in the ICU, and if customization is needed. | CDSS embedded within a commercial prescribing tool with alerts at point of prescribing, pre-written orders with pre-populated fields, and a reference material search tool. | Senior and junior ICU doctors (n = 34). |
Sheehan et al., 2013, USA [68] | Qual | Describe ED sociotechnical environment to inform the design of future CDSS development for pediatric trauma. | Clinical prediction rule for children with minor blunt head trauma. | ED physicians, nursing staff and leadership, clinical IT leadership (n = 126); 90 h of workflow observations. |
Strohm et al., 2020, the Netherlands [69] | Qual | Identify barriers and facilitators to AI implementation in clinical radiology in the Netherlands. | Commercial CDSS utilizes AI to complete automated bone maturity assessments based on X-rays of pediatric patients’ hands. | Case studies: seven hospitals. Senior and junior radiologists, legal consultant, clinical physicists, junior technical physicians, senior data scientist, managers, implementation advisors, and innovation managers (n = 24). |
van der Stap et al., 2021, the Netherlands [70] | Qual | Evaluate feasibility and acceptability of symptom management in palliative care CDSS by exploring the views of the system’s future end users. | CDSS combines patient-reported symptom assessment scale with guideline-based recommendations and alerts clinicians to reassess symptoms. | Patient representatives, community and hospital nurses, hospital GPs, and palliative care specialists (n = 51). |
Vandenberg et al., 2017, USA [71] | Qual | Identify facilitators and barriers to use of a CDSS in the ED to improve geriatric prescribing quality. | Prescription order entry set for geriatric patients. | ED prescribers (n = 20). |
Weber et al., 2009, USA [72] | Qual | Explore experiences of using a CDSS for critical care including motives, and values to use or not use the technology. | Commercial CDSS uses 17 physiological variables, age, and a chronic health evaluation to predict patient outcomes. | Physicians and registered nurses (n = 33). |
Yılmaz et al., 2017, Turkey [73] | Mixed methods | Develop and implement CDSS software for nurses working with cancer patients and explore their experiences using the CDSS. | Rule-based software providing diagnosis depending upon changes in laboratory test values and medical treatments. | Nurses (n = 16). |
Zaidi et al., 2012, Australia [74] | Quant | Examine reliability and validity of newly developed scale measuring physicians’ perceptions of barriers and facilitators towards adoption of an antibiotic approval CDSS. | Commercial CDSS that enables approval for prescribing of restricted antibiotics and provides clinical guidelines and decision support. | Junior and senior medical staff, and pharmacists (n = 115). |
Zaidi et al., 2013, Australia [75] | Mixed methods | Examine impact of process evaluation on uptake of web-based CDSS tool for antibiotic stewardship in a university teaching hospital. | Commercial CDSS with clinical guidelines and role-based functionality to prescribe antibiotics at the point of care. | Junior and senior medical staff, and pharmacists (n = 42). |