title: Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study.
abstract: BACKGROUND
  Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current studies exploring health professionals' perceptions of CDSSs focus primarily on technical and usability issues, overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake across different stages of implementation.
  
  
  METHODS
  We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline physicians, nurses, information technology staff, and members of the hospital board of directors. We will use semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until no new information is gained from the interviews.
  
  
  CONCLUSIONS
  CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be considered when planning their introduction in healthcare settings. The findings of this study will guide the development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake will better capture the complexity of roles and contextual factors affecting CDSS uptake.
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milan, 20133, Italy. lorenzo.moja@unimi.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
authors.forename: Elisa Giulia
authors.initials: EG
authors.lastname: Liberati
authors.forename: Laura
authors.initials: L
authors.lastname: Galuppo
authors.forename: Mara
authors.initials: M
authors.lastname: Gorli
authors.forename: Marco
authors.initials: M
authors.lastname: Maraldi
authors.forename: Oriana
authors.initials: O
authors.lastname: Nanni
authors.forename: Giulio
authors.initials: G
authors.lastname: Rigon
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
authors.forename: Francesca
authors.initials: F
authors.lastname: Ruggiero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaratti
authors.forename: Alberto
authors.initials: A
authors.lastname: Vaona
authors.forename: Koren Hyogene
authors.initials: KH
authors.lastname: Kwag
mesh_terms: D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical / Q000458:organization & administration / Q000706:statistics & numerical data; D006751:Hospital Information Systems; D006782:Hospitals, Special / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D012107:Research Design; D018581:Technology Transfer