Newton Nicki, Bamgboje-Ayodele Adeola, Forsyth Rowena, Bruce Lenert, McPhail Steven M, Shaw Tim, Naicker Sundresan, Tariq Amina, Baysari Melissa T
Digital Health Human Factors Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Department of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Appl Clin Inform. 2025 Aug;16(4):777-785. doi: 10.1055/a-2581-6236. Epub 2025 Apr 11.
Despite their potential, Clinical Decision Support (CDS) systems often lack alignment with clinicians' needs and are underutilized in practice. Pilot implementations can help to improve the fit between systems and local needs by engaging users in real-world testing and refinement. Although pilot implementations of CDS have been reported, limited evidence has explored the factors contributing to pilot success.This study aimed to explore the opportunities and challenges associated with the pilot implementation of a CDS system that ultimately did not progress to full-scale implementation.We conducted interviews with clinicians, health service managers, and vendors involved in the pilot implementation and use of a mobile application-based CDS, and a dashboard-based CDS in two departments (Emergency and Patient Flow) of a rural Australian hospital. A semistructured interview guide was developed using the Non-adoption, Abandonment, Sustainability, Scale-up, and Spread (NASSS) framework. Interviews were audio-recorded, transcribed, and thematically analyzed.Analysis revealed four major themes: system performance and design, implementation processes, organizational support and resources, and perceived benefits of the CDS. The pilot implementation allowed for greater user input into the iterative design of CDS in practice, particularly in the Emergency Department (ED), where clinicians had both the capacity and willingness to engage. However, technical issues encountered early in the pilot deterred many users who did not re-engage even after issues were resolved. Although some users remained engaged, they became frustrated as organizational resource constraints meant that critical issues impacting the CDS's clinical utility went unresolved.Successful CDS pilots depend on the readiness of organizations, departments, and users to engage in pilot activities. Pilot implementations should be pursued in settings where users have both the capacity and willingness to participate in iterative feedback processes and where organizations have sufficient resources to address emerging needs.
尽管临床决策支持（CDS）系统具有潜力，但它们往往与临床医生的需求不一致，在实践中的利用率也很低。试点实施可以通过让用户参与实际测试和改进来帮助提高系统与当地需求的契合度。虽然已经报道了CDS的试点实施情况，但探索促成试点成功的因素的证据有限。本研究旨在探讨与一个最终未推进到全面实施的CDS系统试点实施相关的机遇和挑战。我们对参与澳大利亚一家农村医院两个科室（急诊科和患者流程科）基于移动应用的CDS以及基于仪表板的CDS试点实施和使用的临床医生、卫生服务管理人员和供应商进行了访谈。使用非采用、放弃、可持续性、扩大规模和推广（NASSS）框架制定了半结构化访谈指南。访谈进行了录音、转录并进行了主题分析。分析揭示了四个主要主题：系统性能和设计、实施过程、组织支持和资源以及CDS的感知效益。试点实施使得在实践中用户能够更多地参与CDS的迭代设计，特别是在急诊科，那里的临床医生既有能力也有意愿参与。然而，试点早期遇到的技术问题使许多用户望而却步，即使问题解决后他们也没有再次参与。尽管一些用户仍在参与，但他们感到沮丧，因为组织资源限制意味着影响CDS临床效用的关键问题未得到解决。成功的CDS试点取决于组织、部门和用户参与试点活动的准备情况。应在用户既有能力又有意愿参与迭代反馈过程且组织有足够资源满足新出现需求的环境中进行试点实施。
