Methods used to evaluate clinicians’ acceptance and use of clinical decision support systems over time: a systematic review

Nicki Newton, Adeola Bamgboje-Ayodele, Rowena Forsyth, Amina Tariq, Melissa Baysari

Background: Clinical decision support systems (CDSS) can enhance the safety and quality of patient care, but their benefits are often limited by low acceptance and use by clinicians in practice. While clinicians’ needs may change as they gain experience and familiarity with new systems, limited work has focused on appropriate methods to evaluate early and ongoing acceptance and use of CDSS post implementation.

Aims: To identify and summarise the methods used to capture clinicians’ acceptance and use of CDSS at different time points following implementation in hospital settings and identify gaps to inform future work.

Methods: A systematic review was conducted to identify studies that reported clinicians’ perceptions, attitudes, or interactions with integrated CDSS in live hospital settings. Methods used to evaluate clinicians’ acceptance and use of CDSS, and when they were employed following implementation, were extracted from identified studies.

Results: Of 2963 citations screened, 76 studies met full inclusion criteria. Studies primarily employed quantitative or mixed methods to assess acceptance and use. Qualitative methods were seldom used during the early phases of implementation and few studies captured progression of use over time.

Conclusions: User experiences of CDSS are rarely explored in depth during the early phases of implementation, providing us with limited evidence on user needs at this critical time point. Further work is needed to examine initial acceptance of CDSS and changes in use over time.