Barriers and strategies in Implementing Clinical Decision Support System in Hospitals: A Case Study in Iran

Introduction: Most modern medical issues are inherently complicated and accuratedecisions are not always likely to be made based on logical reasons. Furthermore, thehuge volume of information relevant to a simple diagnostic area makes this decisionmaking even more troublesome. Hence, with the advent of technology, there is an everincreasing need for the Clinical Decision Support System (CDSS) in hospitals. This studyhas been conducted in an Iranian hospital with the aim of identifying the most significantbarriers for implementing CDSS and suggesting appropriate strategies to remove them.Methods: This qualitative cross-sectional study was conducted in 2015. The samplepopulation of the study included 180 physicians and nurses in Shahid Mohammadi hospitalin Bandar Abbas whose performance was changed using CDSS. The participants wereselected using stratified sampling from 23 different wards in the hospital. First, the barriersand strategies for implementation of CDSS in other countries were extracted from a reviewstudy which was used to make a preliminary model. Then, the results of a questionnaire andDelphi tests in three rounds were included in the final model.Results: The most significant barriers in implementing CDSS were categorized into 6groups according to the participants. These include barriers from human resources andinfrastructures as well as financial, technical, environmental and legal ones. The barriers forthem were divided into 5 categories including structural, technical, financial, human andenvironmental ones.Conclusion: Since the most significant obstacle in implementing CDSS in this hospital wasfrom humans, the hospital can use the barriers provided in 5 categories and better benefitfrom the system. These barriers are training the human resources before they start working,engaging them in implementation process of the CDSS and using evidence-based scientificdatabases in CDSS while removing fundamental barriers to the system.

Keywords:

Decision Support System , Clinical , Information Systems , Medical Informatics