Barriers to Widespread Adoption of a Clinical Decision Support System

Barriers to Widespread Adoption of a Clinical Decision Support System
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Abstract
The paper critically evaluates various issues that act as barriers to the widespread adoption of CDSS. The importance of CDSS is briefly explained, and the reason why it continues to be introduced in different healthcare organizations is also explained. Barriers such as fear of misinterpretation of clinical datasets and fear that the system is complex to use are also extensively discussed. The paper also discusses how fear of risk and liability due to the uptake of CDSS and lack of societal acceptance hinders clinicians from adopting this system. Furthermore, the paper also describes how adequate training, creating an organizational culture that encourages the adoption of new systems, and the involvement of clinicians in the creation and implementation phases of CDSS could contribute to its widespread adoption. It also concludes by demonstrating the necessity and importance of CDSS getting used in the medical field.
Barriers to Widespread Adoption of a Clinical Decision Support System
 The clinical decision support system (CDSS) continues to be introduced in different countries with the aim of improving medical care. CDSS plays an integral role in providing essential information and knowledge in a healthcare facility, and this aids in enhancing healthcare provision. The adoption of CDSS has a lot of benefits for the medical field since it reduces the unnecessary variation that tends to arise in clinical practice (Ford et al., 2021, p.9). Additionally, it also aids in ensuring that there is an increase in individuals adhering to evidence-based medical knowledge. However, despite the many benefits that come with the use of CDSS in hospitals, there are still various key barriers to the widespread adoption of this system (Musen, 2021, p.801). Yang (2019,p.9) depicts that a significant number of healthcare providers continue to oppose the adoption of CDSS, claiming that they have better judgment when dealing with complex conditions than taking guidelines from a system. The paper will discuss how legal issues, physician beliefs when dealing with complex medical cases, accountability needed when using CDSS, computer literacy, and clinicians' attitudes towards scientific guidelines are key barriers to the widespread adoption of CDSS.
Assumption that CDSS may not fit into the routine work of a clinician
A significant percentage of clinicians have a negative attitude toward the use of CDSS, and this has continued to act as a hindrance to its widespread adoption. First, the poor attitude is because the medical practitioner deems accessing CDSS a cumbersome process (Ford et al., 2021, p.12). It is deemed cumbersome due to its complexity. When using this system, a healthcare practitioner needs to run back and forth from one computer station to another before fully completing a diagnosis. Consequently, with the heavy workload that practitioners have, most of them deem this system ineffective, which continues to act as a barrier to its adoption. Secondly, Zhang (2020, p.295) portrays that most clinicians believe they have better experience dealing with medical matters than taking guidelines from a computerized system. As a result, they chose not to rely on the evidence presented by CDSS, although it may be accurate, as they feel they have the needed skills to competently provide care to patients.
Thirdly, CDSS is portrayed as not being able to fit into the routine work of a clinician since it can contribute to burnout and frustration. Liberati (2017, p.10) states that a lot of time is consumed because of the amount of data required to be fed for a given diagnosis and guide to be made. Thus, the healthcare provider will feel frustrated because they still have to serve patients diligently and feed the necessary information to the system. Burnout could largely contribute to occupational injury and substance abuse among healthcare providers. Furthermore, this would result in decreased patient satisfaction as the clinician would be experiencing burnout. Therefore, the fear that despite CDSS reducing medical errors, it would result in burnout acts as a barrier to its widespread adoption.
Furthermore, Sutton et al. (2020) note that another barrier to the adoption of CDSS is that it is said to cause fragmented workflow. Where CDSS are stand-alone systems, cases of disruption in the clinical workflow are mainly experienced. Also, the fear that the adoption of CDSS may lead to failure to verify the accuracy of an order also bars most healthcare providers from adopting this system. The healthcare provider did the role of exclusively double-checking orders, but with CDSS, this may not be the case. Consequently, healthcare providers feel that errors are likely to occur due to fatigue caused by filling in all the necessary data when using the CDSS and overreliance on this system.
Fear of misinterpretation of clinical datasets
According to Liberati (2017, p.9), since the CDSS stores a lot of clinical information, this important information might be misinterpreted. The main reason for this is inconsistency in data coding between different systems. When CDSS was formulated, the main objective was to ensure there was an improvement in the overall safety of patients and that the quality of care delivery also improved. However, this system is still not being adopted in many health care facilities because of the fear that is always relying on the evidence retrieval system will most likely result in decision error.
Fear of diagnostic errors also pushes healthcare providers to avoid adopting the use of CDSS. According to Sutton et al. (2020), diagnostic errors are likely to occur due to some information that may be lacking in the CDSS. Thus, it may result in diagnostic errors, care gaps, patient harm, and sometimes unnecessary procedures. It can also result in much serious consequences, such as hospital death, and all of this is because some information was lacking in the CDSS. Thus, due to the fear that the information presented is prone to misinterpretation and diagnostic errors, most healthcare providers shun adopting CDSS.
The fear that the CDSS is too complex to use
Wasylewicz (2019, p.154) is keen on portraying a large percentage of senior clinicians who deem CDSS unnecessary due to their experience level. When a physician makes clinical decisions, they are required to do this based on the patient's information, their individual morality, and social structure. Consequently, most physicians feel that despite the level of advancement in technology, the CDSS does not fully incorporate all these factors when making clinical decisions. Hence, they term the system complex to use and not equipped enough to give competent clinical decisions.
A significant number of healthcare providers fear that adopting CDSS will reduce their professional autonomy, which continues to hinder the widespread adoption of this system. Furthermore, for effective use of CDSS, there is a need for one to be computer literate. Consequently,   the lack of adoption of this system is because some healthcare providers feel that the system is complex to use despite the training. Therefore, they feel that more errors are likely to occur due to the complexity of using the CDSS instead of a reduction of errors. Additionally, due to a lack of enough training on how to use the system, some clinicians assume that the CDSS is ineffective, which has hindered its widespread adoption. Furthermore, Liberati et al. (2017, p.8) point out that clinicians' perception that CDSS may be used against them in case of an error also acts as a barrier.
Fear of risk and liability associated with uptake of CDSS
According to Sutton et al. (2020), the adoption of CDSS in...