Prescriber perceptions of medication-related computerized decision support systems in hospitals: a synthesis of qualitative research

Objective: To identify factors that prevent and promote uptake of medication-related computerized decision support systems (CDSS) in hospitals, based on the perceptions of prescribers. Materials and methods: Databases Medline, Embase, CINAHL, PubMed and PsycINFO and the top five medical informatics journals were searched. English papers published after 2002, which used a qualitative approach to examine prescriber views of CDSS in hospitals were included. Qualitative data were extracted and mapped to the three domains of the HOT-fit framework (human, organization, and technology). Results: Factors preventing CDSS uptake were perceived threats to autonomy, CDSS conflicting with personal prescribing preferences, and mistrust of CDSS information. Factors promoting CDSS uptake were perceptions that CDSS improves safety and efficiency, and is easy to use. With respect to medication alerts, large numbers of irrelevant alerts reportedly led to alerts being ignored. When using order sentences/order sets, long lists of options led to excessive scrolling or clicks, and resulted in users opting for free text ordering. Discussion and conclusion: To promote medication-related CDSS uptake, it is recommended that prescribers’ perspectives on CDSS usability and integration into workflow be sought during the design phase, that evidence on CDSS’ effectiveness to improve safety be provided to prescribers, and that system information be kept up to date. To improve alert uptake, organizations should ensure that alerts and minimal and relevant. To improve uptake of order sentences/order sets, organizations should minimise the number of options available to prescribers. Future work should focus on exploring prescriber perceptions of other types of CDSS.