title: User perspectives on an electronic decision-support tool performing comprehensive medication reviews - a focus group study with physicians and nurses.
abstract: BACKGROUND
  Although a number of studies have evaluated the effectiveness of computerized decision-support systems (CDSS), there is lack of data on user perspectives, barriers, and facilitators to the implementation of CDSSs in real-life surroundings. The aim of this study was to assess individually perceived barriers, facilitators and ideas influencing the CDSS implementation and usability.
  
  
  METHODS
  In this qualitative study, five focus groups were carried out with physicians and nurses separately at the Tampere City Health Center, Finland. The participants were end-users of the EBMeDS computerized decision support system. An explorative data content analysis was applied.
  
  
  RESULTS
  The most important barrier to benefitting from CDSS was the lack of structured and coded diagnosis documentation and outdated medication information in the electronic health records. This led to false alerts and distrust towards the system. Among the major facilitators found were e.g. the beneficial reminders that helped practitioners take into account matters otherwise ignored; automatic glomerular filtration rate (GFR) calculations; medication safety checks; and the summaries in the single medication review at a glance.
  
  
  CONCLUSIONS
  Physicians' and nurses' are keen to use the CDSS and it may enhance their inter-professional collaboration. Documenting patient information in a structured, uniform and easy manner is the essential starting point for electronic decision support. When implementing CDSS, managers need to focus on common practices in documenting structured data in their organizations in order to prevent undermining trust in the system.
authors.affiliation: University of Tampere, Department of General Practice, Lääkärinkatu 1, 33014, Tampereen yliopisto, Finland. tuomas.koskela@uta.fi.|Duodecim Medical Publications Ltd, PO Box 874, 00101, Helsinki, Finland. tuomas.koskela@uta.fi.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Koskela
authors.affiliation: Nordic Healthcare Group Ltd (at the time of the study), Vattuniemenranta 2, 00210, Helsinki, Finland. saana.sandstrom@gmail.com.
authors.forename: Saana
authors.initials: S
authors.lastname: Sandström
authors.affiliation: Duodecim Medical Publications Ltd, PO Box 874, 00101, Helsinki, Finland. joonas.makinen@duodecim.fi.
authors.forename: Joonas
authors.initials: J
authors.lastname: Mäkinen
authors.affiliation: School of Primary, Aboriginal and Rural Health Care, University of Western Australia (M706), 35 Stirling Highway, Crawley, WA, 6009, Australia. helena.liira@uwa.edu.au.
authors.forename: Helena
authors.initials: H
authors.lastname: Liira
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D020000:Decision Support Systems, Clinical / Q000592:standards*; D011307:Drug Prescriptions; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009726:Nurses; D010820:Physicians; D036301:Qualitative Research