Barriers and facilitators to the implementation and adoption of computerised clinical decision support systems: an overview of reviews
Clinical Snapshot
PICO Framework
| P — Population | Healthcare settings and practitioners implementing computerised clinical decision support systems (CDSSs) |
| I — Intervention | Implementation and adoption of computerised clinical decision support systems |
| C — Comparator | Not applicable (overview of reviews examining barriers and facilitators) |
| O — Outcomes | Barriers and facilitators to CDSS implementation and adoption across healthcare settings |
Bottom Line
This comprehensive overview synthesises evidence from 721 primary studies to identify 101 factors influencing computerised clinical decision support system implementation. The six most critical factors are usability, perceived usefulness, organisational readiness, training, trust, and workflow integration. These findings provide healthcare leaders with an evidence-based framework for successful CDSS implementation. The research emphasises that technical performance alone is insufficient - human and contextual factors are equally important. For Australian healthcare settings, this evidence supports strategic planning for digital health initiatives, ensuring consideration of user acceptance, organisational culture, and workflow compatibility. Healthcare organisations should conduct comprehensive readiness assessments addressing all three domains (human, technological, contextual) before CDSS deployment. The study's robust methodology and large evidence base make it a reliable resource for implementation planning across diverse healthcare environments.
Key Findings
P Value: Not applicable for qualitative synthesis
Effect Size: Six most frequently reported factors: usability, usefulness/perceived benefits, organisational readiness, training, trust, and workflow integration
Primary Outcome: 101 distinct factors influencing CDSS implementation and adoption identified
Nnt Or Sensitivity: Evidence synthesis from 30 reviews covering 721 unique primary studies
Confidence Interval: Not applicable for qualitative synthesis
Clinical Application
Highly feasible - provides practical framework for addressing implementation challenges in real-world healthcare settings Directly relevant to Australian healthcare digitalisation initiatives, My Health Record integration, and TGA-approved clinical decision support tools. Aligns with RACGP digital health guidelines and supports PBS medication management systems. Healthcare organisations and practitioners implementing or considering CDSS adoption across all clinical specialties
Abstract
BACKGROUND: The use of computerised clinical decision support systems (CDSSs) holds considerable potential in enhancing healthcare delivery by improving patient safety, practitioner performance, and patient outcomes. However, despite the numerous reported advantages of CDSSs, their adoption remains restricted, thereby compromising the full realisation of their potential. To enable a profound evaluation and successful implementation of these systems, it is imperative to identify the reasons for their limited uptake. The objective of this study is to provide a comprehensive overview of the barriers and facilitators to the implementation and adoption of decision support systems across healthcare settings. METHODS: This study was reported in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) statement. A systematic search was conducted in the databases PubMed, IEEE Xplore, Scopus, and Web of Science from inception to 15 October 2024, targeting at review articles of primary studies focusing on the identification and reporting of barriers and facilitators to the implementation and adoption of CDSSs across healthcare settings. The risk of bias of the included reviews was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool, and the primary study overlap was calculated using the corrected covered area method. All data on barriers and facilitators to the implementation and adoption of CDSSs were extracted from the included reviews, synthesised through a mapping of identical factors, and ranked according to their frequency of occurrence. RESULTS: Of the 1640 records retrieved through database searches, 30 reviews were included in this overview, which summarised the findings of 721 unique primary studies. A total of 101 distinct factors influencing the implementation and adoption of CDSSs were identified and could be categorised into the overarching categories of human, technology-related, and contextual factors. The following six factors were reported most frequently: usability, usefulness/perceived benefits, organisational readiness, training, trust, and workflow integration. CONCLUSIONS: The findings of this study highlight the diversity of factors that influence a successful implementation of CDSSs and emphasise the need for their comprehensive evaluation that goes beyond the assessment of general performance aspects but takes into account human and contextual factors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024507614.
References
- 1.Böhm-Hustede, A. K., Lubasch, J. S., Hoogestraat, A. T., Buhr, E., & Wulff, A. (2026). Barriers and facilitators to the implementation and adoption of computerised clinical decision support systems: an overview of reviews. Systematic Reviews. https://doi.org/10.1038/s41598-023-40290-7
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