title: Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings.
abstract: BACKGROUND
  Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources) for the change and strategies to implement and maintain new systems.
  
  
  METHODS
  To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D) in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners) participated across five sites, accruing over 300 outpatient visits on 168 patients.
  
  
  RESULTS
  Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping.
  
  
  CONCLUSIONS
  The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.
authors.affiliation: Mood Disorders Research Program & Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, TX, USA. madhukar.trivedi@utsouthwestern.edu
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Ella J
authors.initials: EJ
authors.lastname: Daly
authors.forename: Janet K
authors.initials: JK
authors.lastname: Kern
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Grannemann
authors.forename: Prabha
authors.initials: P
authors.lastname: Sunderajan
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Claassen
mesh_terms: D001292:Attitude to Computers; D020000:Decision Support Systems, Clinical; D003863:Depression; D004059:Diffusion of Innovation; D006801:Humans; D019370:Observation; D013781:Texas