Identifying clinicians’ needs for the acceptance and use of hospital clinical decision support systems over time

Abstract

Background: Clinical Decision Support (CDS) systems are essential for improving care quality and efficiency, yet they are often underutilised by clinicians. While much prior research has investigated why clinicians accept and use CDS systems, studies typically take a static perspective. This overlooks the dynamic nature of healthcare environments, where users, systems, and organisational contexts are continually changing.

Aims: This thesis investigated how clinicians’ needs for the acceptance and use of hospital-based CDS change over time, from implementation to sustained use, and how strategies could be applied to meet time-sensitive needs.

Methods: The mixed-methods approach included three systematic reviews, two qualitative studies, and a mixed-methods study. Reviews synthesised evidence on user involvement in CDS design, methods used to evaluate CDS acceptance and use, and factors influencing CDS acceptance and use over time. Qualitative studies explored clinicians' early experiences with a CDS piloted in a rural hospital, and doctors’ experiences of alert fatigue associated with routinely embedded CDS. A mixed-methods study compared junior doctors’ perceptions and interactions with CDS.

Results: Clinicians’ needs shifted over time. Early impressions strongly influenced long-term use and were shaped by user characteristics, expectations, and system performance. Lack of familiarity, value and efficiency were common early concerns, but could be mitigated with enhanced usability, clinician involvement, and organisational support. Perceived value and workflow fit remained important throughout. Routine use, and disuse, was shaped by self-efficacy, habits, attitudes, and integration into workflows and culture, but could be disrupted when CDS was not adapted as other elements of the work system evolved.

Conclusions: This thesis demonstrates that clinicians’ acceptance and use of CDS is a dynamic process that must be actively supported throughout the system lifecycle.