Unlocking the potential of Clinical Decision Support Systems: a collaborative approach to prioritising and implementing digital health research

The implementation of clinician-facing digital health technologies, particularly clinical decision support systems, is complex, and often hampered by poor user acceptance, uptake and workflow integration. Poor clinician uptake of clinical decision support systems stems from reasons such as how well the technology fits their workflow, their level of trust in the system, whether the system is well-designed, and who is responsible or liable if the system’s recommendations are incorrect. Therefore, it is not surprising to note that only 34% of clinical decision support (CDS) systems that are implemented in practice, are being used by clinicians. This results in a significant waste of resources invested in these technologies and an unfulfilled promise of improving outcomes for patients. Hence, the question of how we can design and implement CDS systems so that clinicians want to use them, remains unanswered.

In acknowledging the challenges associated with the implementation of CDS systems into practice, a collaborative translational research project was initiated between university, health services and industry partners, to investigate how CDS systems can be successfully implemented and used to optimise healthcare delivery from both a clinician (end-user) and governance perspective. With multiple candidate CDS systems available for implementation, the first phase of this project involved prioritising and selecting use cases for our research that enable a focus on embedding into practice. As no existing research had examined the criteria used for prioritising clinician-facing technologies, such as CDS systems, for research, we conducted an initial study to fill this knowledge gap. The aim of the initial study was to (a) identify the criteria for prioritising digital health research and examine how these differ from criteria for prioritising traditional health research, and (b) determine priority CDS system use cases for our collaborative research programme.

Interviews and workshops were conducted with all stakeholders involved in our collaborative research project. We identified criteria unique to prioritising digital health research and selected 3 use cases from 12 which were originally identified as of interest to the stakeholders. Further work is underway to unpack the barriers and enablers to the use of CDSS relevant to one of the use cases. Our prioritisation process could be applied to other settings and collaborative projects where research institutions partner with healthcare delivery organisations.

Read Adeola’s full research paper here