A scoping review, novel taxonomy and catalogue of implementation frameworks for clinical decision support systems

Abstract

Background: The primary aim of this scoping review was to synthesise key domains and sub-domains described in existing clinical decision support systems (CDSS) implementation frameworks into a novel taxonomy and demonstrate most-studied and least-studied areas. Secondary objectives were to evaluate the frequency and manner of use of each framework, and catalogue frameworks by implementation stage.

Methods: A scoping review of Pubmed, Scopus, Web of Science, PsychInfo and Embase was conducted on 12/01/2022, limited to English language, including 2000-2021. Each framework was categorised as addressing one or multiple stages of implementation: design and development, evaluation, acceptance and integration, and adoption and maintenance. Key parts of each framework were grouped into domains and sub-domains.

Results: Of 3550 titles identified, 58 papers were included. The most-studied implementation stage was acceptance and integration, while the least-studied was design and development. The three main framework uses were: for evaluating adoption, for understanding attitudes toward implementation, and for framework validation. The most frequently used framework was the Consolidated Framework for Implementation Research.

Conclusions: Many frameworks have been published to overcome barriers to CDSS implementation and offer guidance towards successful adoption. However, for co-developers, choosing relevant frameworks may be a challenge. A taxonomy of domains addressed by CDSS implementation frameworks is provided, as well as a description of their use, and a catalogue of frameworks listed by the implementation stages they address. Future work should ensure best practices for CDSS design are adequately described, and existing frameworks are well-validated. An emphasis on collaboration between clinician and non-clinician affected parties may help advance the field.

Keywords: Adoption; Clinical decision support system; Design; Development; Evaluation; Frameworks; Implementation; Scoping review.

Fig. 1

PRISMA diagram for literature selection

Fig. 2

Frequency of domains by implementation stage

Fig. 3

Frequency and academic use of published adoption frameworks in scoping review. Legend: The graph represents frequency of use and type of academic use within included studies in this review. The table represents the average number of annual citations since publication of each framework to 2022, in each key search engine (Web of Science and Google Scholar). Frameworks included in our reference list were BEAR (Behaviour and Acceptance Framework; Camacho 2020) [26], CFIR (Consolidated Framework for Implementation Research; Damschroder 2009) [25], GRASP (Grade and Assess Predictive tools; Khalifa 2019) [44], HITREF (Health Information Technology (HIT) Reference-based Evaluation Framework; Sockolow 2015) [54], HOT-FIT (Human, Organisation, and Technology-fit Framework; Yusof 2008) [34], and NASSS (Nonadoption, Abandonment, Scale-up, Spread, and Sustainability; Greenhalgh 2017) [40]. Original frameworks not included in the scoping review included those for RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance framework; Glasgow 1999) [81], UTAUT (Unified Theory of Acceptance and Use of Technology; Venkatesh 2003) [82], TDF (Theoretical Domains Framework; Michie 2005) [83], PRISM (Practical Robust Implementation and Sustainability Model; Aqil 2009) [85], and NPM (Normalization Process Model; May 2009) [84]

Fig. 4

Co-developers catalogue of published frameworks by related implementation stage