title: [Barriers and facilitators to the implementation of computerized decision support systems in Italian hospitals: a grounded theory study].
abstract: BACKGROUND
  Computerized Decision Support Systems (CDSSs) connect health care professionals with high-quality, evidence-based information at the point-of-care to guide clinical decision-making. Current research shows the potential of CDSSs to improve the efficiency and quality of patient care. The mere provision of the technology, however, does not guarantee its uptake. This qualitative study aims to explore the barriers and facilitators to the use of CDSSs as identified by health providers.
  
  
  METHODS
  The study was performed in three Italian hospitals, each characterized by a different level of familiarity with the CDSS technology. We interviewed frontline physicians, nurses, information technology staff, and members of the hospital board of directors (n=24). A grounded theory approach informed our sampling criteria as well as the data collection and analysis.
  
  
  RESULTS
  The adoption of CDSSs by health care professionals can be represented as a process that consists of six "positionings," each corresponding to an individual's use and perceived mastery of the technology. In conditions of low mastery, the CDSS is perceived as an object of threat, an unfamiliar tool that is difficult to control. On the other hand, individuals in conditions of high mastery view the CDSS as a helpful tool that can be locally adapted and integrated with clinicians' competences to fulfil their needs. In the first positionings, the uptake of CDSSs is hindered by representational obstacles. The last positionings, alternatively, featured technical obstacles to CDSS uptake.
  
  
  CONCLUSIONS
  Our model of CDSS adoption can guide hospital administrators interested in the future integration of CDSSs to evaluate their organizational contexts, identify potential challenges to the implementation of the technology, and develop an effective strategy to address them. Our findings also allow reflections concerning the misalignment between most Italian hospitals and the current innovation trends toward the uptake of computerized decision support technologies.
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: Francesca
authors.initials: F
authors.lastname: Ruggiero
authors.forename: Matteo
authors.initials: M
authors.lastname: Capobussi
authors.forename: Rita
authors.initials: R
authors.lastname: Banzi
authors.forename: Koren
authors.initials: K
authors.lastname: Kwag
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaratti
authors.forename: Oriana
authors.initials: O
authors.lastname: Nanni
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
authors.forename: Hernan
authors.initials: H
authors.lastname: Polo Friz
authors.forename: Claudio
authors.initials: C
authors.lastname: Cimminiello
authors.forename: Marco
authors.initials: M
authors.lastname: Bosio
authors.forename: Massimo
authors.initials: M
authors.lastname: Mangia
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
mesh_terms: D001292:Attitude to Computers; D003625:Data Collection; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D066296:Grounded Theory; D006751:Hospital Information Systems / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D011787:Quality of Health Care