Discipline of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Australia.
J Am Med Inform Assoc. 2010 Jan-Feb;17(1):25-33. doi: 10.1197/jamia.M3170.
There is wide variability in the use and adoption of recommendations generated by computerized clinical decision support systems (CDSSs) despite the benefits they may bring to clinical practice. We conducted a systematic review to explore the barriers to, and facilitators of, CDSS uptake by physicians to guide prescribing decisions. We identified 58 studies by searching electronic databases (1990-2007). Factors impacting on CDSS use included: the availability of hardware, technical support and training; integration of the system into workflows; and the relevance and timeliness of the clinical messages. Further, systems that were endorsed by colleagues, minimized perceived threats to professional autonomy, and did not compromise doctor-patient interactions were accepted by users. Despite advances in technology and CDSS sophistication, most factors were consistently reported over time and across ambulatory and institutional settings. Such factors must be addressed when deploying CDSSs so that improvements in uptake, practice and patient outcomes may be achieved.
尽管计算机化临床决策支持系统（CDSS）可能会给临床实践带来益处，但它们的使用和采用却存在很大的差异。我们进行了一项系统评价，以探索阻碍和促进医生接受 CDSS 以指导处方决策的因素。我们通过搜索电子数据库（1990-2007 年）确定了 58 项研究。影响 CDSS 使用的因素包括：硬件、技术支持和培训的可用性；系统与工作流程的集成；以及临床信息的相关性和及时性。此外，得到同事认可、最小化对专业自主性的感知威胁、不影响医患互动的系统被用户接受。尽管技术和 CDSS 的复杂性有所提高，但大多数因素随着时间的推移和在门诊和医疗机构环境中一直得到报告。在部署 CDSS 时必须解决这些因素，以便提高采用率、改善实践和提高患者的治疗效果。
