Clinical decision support systems in hospitals: What do physicians expect?

Clinical decision support systems in hospitals: What do physicians expect?


Pieter Cornu, Stephane Steurbaut, Marc De Beukeleer, Koen Putman, Rudi Van de Velde, Alain G Dupont


Background and Objective
As rational pharmacotherapy and medication safety have become central aspects in current healthcare practice, clinical decision support systems (CDSS) are becoming increasingly important. Because developing and implementing CDSS is time-consuming and costly, prioritization of the most relevant systems is warranted. The physician's perspective is an important factor for determining this prioritization. The objective of this study was to investigate the physician's perspective on the perceived usefulness of different types of CDSS in relation to each other and to identify the user needs and expectations regarding future CDSS.

Setting and Method
This study was a cross-sectional single-center (web-based) survey among physicians with a permanent clinical assignment in a 721-bed university hospital. The physicians were questioned about their current experiences with electronic drug prescribing, knowledge regarding CDSS, and the perceived usefulness and desired features of future CDSS.

Main outcome measures
The comparison of the overall scores for the perceived usefulness of different types of CDSS.

Results
One hundred and sixty-four physicians completed the survey (52.6%). More than half (61.6%) of the respondents did not know what CDSS were before completing the survey. The majority of the respondents indicated that it is very difficult to take all relevant information into account when prescribing drugs. Drug-drug interaction checking, drug-allergy checking, and dosing guidance were considered as most useful. Automated clinical guidelines and adverse drug event monitoring were considered as least useful. The user-friendliness of the systems, clinical relevance of the alerts, and related with it, prevention of alert fatigue, were perceived as important aspects for a successful implementation.

Conclusions
From the physicians' perspective drug-drug interaction checking, drug-allergy checking, and dosing guidance should receive the highest priority for development and implementation. The majority of the respondents acknowledged that it is very difficult to take all relevant information into account when prescribing drugs. If physicians are aware of their limitations, they may more easily accept the use of CDSS and overcome the perceived disadvantages. Furthermore, attention should go to the development of user-friendly systems that deliver clinical relevant alerts.