title: Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Vanderbilt University Medical Center, United States; U.S Department of Veteran's Affairs, United States. Electronic address: Anne.miller@vanderbilt.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Miller
authors.affiliation: Perigean Technologies, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Moon
authors.affiliation: Vanderbilt University Medical Center, United States.
authors.forename: Shilo
authors.initials: S
authors.lastname: Anders
authors.affiliation: Vanderbilt University Medical Center, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Walden
authors.affiliation: Vanderbilt University Medical Center, United States; U.S Department of Veteran's Affairs, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Brown
authors.affiliation: Vanderbilt University Medical Center, United States; U.S Department of Veteran's Affairs, United States.
authors.forename: Diane
authors.initials: D
authors.lastname: Montella
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D006302:Health Services Research / Q000458:organization & administration*; D015201:Meta-Analysis as Topic; D036301:Qualitative Research; D018511:Systems Integration; D057188:Workflow
keywords: Clinical decision making; Computerized clinical decision support; Human–computer interaction; Human–system interaction; Meta-synthesis; Qualitative research; Usability; Workflow integration