Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research

Int J Med Inform. 2015 Dec;84(12):1009-18. doi: 10.1016/j.ijmedinf.2015.09.005. Epub 2015 Sep 14.


Purpose: Computerized clinical decision support systems (CDSS) are an emerging means for improving healthcare safety, quality and efficiency, but meta-analyses findings are mixed. This meta-synthesis aggregates qualitative research findings as possible explanations for variable quantitative research outcomes.

Inclusion criteria: Qualitative studies published between 2000 and 2013 in English, involving physicians, registered and advanced practice nurses' experience of CDSS use in clinical practice were included.

Search strategy: PubMed and CINAHL databases were searched. Study titles and abstracts were screened against inclusion criteria. Retained studies were appraised against quality criteria. Findings were extracted iteratively from studies in the 4th quartile of quality scores. Two reviewers constructed themes inductively. A third reviewer applied the defined themes deductively achieving 92% agreement.

Results: 3798 unique records were returned; 56 met inclusion criteria and were reviewed against quality criteria. 9 studies were of sufficiently high quality for synthetic analysis. Five major themes (clinician-patient-system integration; user interface usability; the need for better 'algorithms'; system maturity; patient safety) were defined.

Conclusions: Despite ongoing development, CDSS remains an emerging technology. Lack of understanding about and lack of consideration for the interaction between human decision makers and CDSS is a major reason for poor system adoption and use. Further high-quality qualitative research is needed to better understand human-system interaction issues. These issues may continue to confound quantitative study results if not addressed.

Keywords: Clinical decision making; Computerized clinical decision support; Human–computer interaction; Human–system interaction; Meta-synthesis; Qualitative research; Usability; Workflow integration.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Decision Support Systems, Clinical / organization & administration*
  • Health Services Research / organization & administration*
  • Meta-Analysis as Topic*
  • Qualitative Research*
  • Systems Integration
  • Workflow