School of Nursing, Fudan University, Shanghai 200032, China; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Int J Med Inform. 2022 Oct;166:104841. doi: 10.1016/j.ijmedinf.2022.104841. Epub 2022 Aug 19.
Clinical decision support systems (CDSSs) have been increasingly introduced to health care settings; however, their adoption is far from ideal. Guided by the FITT framework, this study aims to explore barriers and facilitators to the implementation of a CDSS from the perspective of nurses.
A qualitative study with 200 h of participatory observation and 21 semi structured interviews was conducted from February to August 2021 in four medical-surgical wards in a 2000-bed tertiary hospital in Shanghai, China. The field notes were typed and the audio-recorded interviews were transcribed to texts verbatim and were coded with a four-step approach. We used the FITT framework to interpret our findings based on the technology, individual and task attributes and the fit between them.
A total of twelve categories were identified, which were integrated into two themes: barriers and facilitators to system implementation. All categories but one can be mapped to the three attributes of the FITT framework: technology, individual and task. We assumed that management has a vital role to play in the following areas: addressing user resistance, improving system usability, setting standards on practice and, finally, building connectivity between nurses and the technical staff to improve the fit between the technology, individual and task attribute and thus promote system implementation.
Barriers and facilitators to CDSS implementation include system-related, user-related and organizational factors which can largely be fit into the FITT framework. There is potential to extend the FITT framework to represent management intervention on inter-disciplinary collaboration. Future empirical studies on facilitating strategies from the management to improve user experience and willingness of CDSS adoption are needed.
临床决策支持系统（CDSS）已越来越多地引入医疗保健环境；然而，它们的采用远非理想。本研究以 FITT 框架为指导，旨在从护士的角度探讨 CDSS 实施的障碍和促进因素。
这是一项定性研究，于 2021 年 2 月至 8 月在中国上海一家拥有 2000 张床位的三级医院的四个外科病房进行，共进行了 200 小时的参与式观察和 21 次半结构化访谈。现场记录被打字，录音访谈被转录成逐字文本，并采用四步方法进行编码。我们使用 FITT 框架根据技术、个人和任务属性及其之间的适配来解释我们的发现。
共确定了十二个类别，这些类别被整合为两个主题：系统实施的障碍和促进因素。除了一个类别外，所有类别都可以映射到 FITT 框架的三个属性：技术、个人和任务。我们假设管理层在以下方面发挥着至关重要的作用：解决用户抵制、提高系统可用性、制定实践标准，最后，在护士和技术人员之间建立连接，以改善技术、个人和任务属性之间的适配，从而促进系统实施。
CDSS 实施的障碍和促进因素包括系统相关、用户相关和组织因素，这些因素在很大程度上可以适应 FITT 框架。有可能将 FITT 框架扩展为代表管理层干预跨学科协作。需要进一步开展关于管理干预措施的实证研究，以改善用户体验和采用 CDSS 的意愿。
