Table 3 Barriers and facilitators identified in key constructs over time
From: A systematic review of clinicians’ acceptance and use of clinical decision support systems over time
CFIR domain | CFIR construct | Timeframe | ||||
|---|---|---|---|---|---|---|
0–6 months | 7–12 months | 1–2 years | 2–5 years | 5+ years | ||
Intervention | Complexity | • Ease of use (−/+) • Time and effort (−/+) • Ease of learning (+) | • Time and effort (−/+) • Ease of use (+) | • Ease of use (+/−) • Time and effort (−) • Cognitive overload (−) | ||
Data Quality | • Recommendation quality (−/+) | • Recommendation quality (−/+) • Data inputs not trusted (−) | • Recommendation quality (−) | |||
Design Quality and Packaging | • Integration of CDS with other systems e.g. EHR (−/+) • Interface design quality (−/+) • Too much/too little information (−) • Valuable system features (+) • Limited visibility and transparency (−) • Design of CDS rules or algorithms (−/+) | • Valuable system features/additional features needed (−/+) • Integration of CDS with other systems (−/+) • Too much information (−) | • Integration of CDS with other systems (+) • Automaticity of CDS (limited use of passive alerts, negative perceptions of interruptive alerts) (−) | • Additional needs for system features, rules/algorithms, and interface design identified (−) | ||
Relative Advantage | • Usefulness and utility (−/+) • System performance (−/+) • Preferences for alternate systems (barriers where CDS competed with homegrown CDS and CDS available online; facilitators where CDS was previously paper based) (−/+) • Efficiency over previous system (+) • Satisfied (+) | • Usefulness and utility (−/+) • Preferences for alternate systems (−/+) • System performance (−/+) | • Usefulness and utility (−/+) • Efficiency over previous system (+) • Poor system performance (−) | • Usefulness and utility (+) | ||
Evidence strength and quality | • Evidence-based and credible (+) | |||||
Inner Setting | Available Resources | • Training (−/+) • Information available (e.g. user manuals, instructions) (−) | • Training (+) | |||
Compatibility | • Workflow fit (−/+) • Interrupts workflow (−) • Alert fatigue (−/+) | • Workflow fit (−/+) • Duplication/less duplication of work (−/+) | • Workflow fit (−/+) | • Duplication of work (−) | • Workarounds (−/+) • Alert fatigue and reductions in alert fatigue following modifications (−/+) | |
Task and Work Context | • Time pressure and existing workload (−) • Useful or not useful for specific clinical tasks or patients (−/+) | • Time pressure and existing workload (−) • Useful or not useful for specific clinical tasks (−/+) | • Useful or not useful for specific clinical tasks or patients (e.g. complex patients) (−) | |||
Individuals | Individual stage of change | • Early impressions of CDS (−) | ||||
Self-Efficacy | • Lack of understanding and skills to use CDS (−) | • Lack of vs. sufficient understanding and skills to use CDS (−/+) • Potential for over reliance (−) • CDS used alongside clinical judgement (−/+) | • CDS used alongside clinical judgement and prior experience (−/+) | |||
Outcomes | Innovation Deliverers | • Improved staff communication and collaboration (+) • Improved/impaired clinical decision making (−/+) • Prompted consideration (+) • Enhanced confidence (+) • Increased/reduced efficiency (−/+) | • Reduced/did not reduce workload (−/+) Prompted consideration (+) Improved staff communication and collaboration (+) Increased efficiency (+) | |||
Innovation Receivers | • Improved/did not change patient care (−/+) Improved/reduced patient safety (−/+) • Increased patient communication (+) • Improved/did not change patient outcomes (−/+) • More timely care (+) | • Improved (e.g. reduced errors) /reduced patient safety (incl. new system-related errors) (−/+) • Delays in care (−) • Improved patient care (+) | ||||
