Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis

Abstract

Objective: To provide an integrated and differentiated understanding of factors influencing guideline-based CDSS implementation and illustrate the gaps in the current literature.

Materials and methods: A systematic literature review and in-depth exploration of factors impeding or facilitating successful implementation of guideline-based CDSS supporting physicians in clinical decision-making was performed. Factors were identified thematically by textual analysis of the included publications and were individually mapped to the human, organization and technology-fit (HOT-fit) framework for evaluating implementations of health information systems.

Results: A total of 421 factors were found in 35 included publications from a total of 3676 publications. The mapping of factors concerning CDSS implementation on the HOT-fit framework revealed gaps in each domain of the framework and showed that research has mainly focused on human and technology factors and less on organizational factors.

Conclusions: Future research within the field of guideline-based CDSS should focus on evaluating implementations through the use of socio-technical models to study guideline-based CDSS system implementations from a multidimensional view. Furthermore, research is needed to explore whether use of these models during the planning phases of a CDSS project is useful in anticipating and preventing implementation barriers from occurring and exploiting facilitators to a successful implementation of the system.

Keywords: Clinical decision support system; Clinical guidelines; Human factors engineering; Implementation success.