A systematic review of clinicians' acceptance and use of clinical decision support systems over time.

Existing reviews have identified factors influencing Clinical Decision Support (CDS) adoption by clinicians in practice but overlook the dynamic and evolving nature of technology and users' needs over time. This review aimed to identify factors that influence early, mid-term, and sustained acceptance and use of CDS in hospital settings. Five databases were searched from 2007 to January 2024 and 67 papers were included. Factors were extracted and synthesised according to the time that data were collected following CDS implementation. Factors relating to the CDS intervention (e.g. utility) and inner setting (e.g. fit with workflows) were reported across all time periods. Perceived outcomes were more often identified in the first year of use, and individual factors after the first 6 months of use. Strategies to work around CDS limitations were reported 5 years after implementation. Our review provides guidance for developing, implementing, and supporting ongoing use of CDS systems.