Barriers and facilitators to implementing a nursing clinical decision support system in a tertiary hospital setting: A qualitative study using the FITT framework

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

“…As expected, our review saw a range of studies focusing on different technologies and across different system levels. Many of the surveyed papers studied HOFs using specific technologies including mental health consultation [20,21], online consultations [22,32], clinical decision support systems (CDSS) [23], electronic medication management systems [24], video consultation [25][26], aged care systems [27] and telemedicine [36]. The context of use for these systems included hospitals [23,[28][29][30][31][32][33][34], residential aged care homes [27], and community health facilities [35].…”

“…Their study showed that social welfare professionals scored a system more favourable than physicians or nurses due to the fact the latter two professions have a more hectic work environment including higher documentation demands [42]. Zhai et al [23] used the Fit between Individuals, Task, and Technology (FITT) framework to study CDSS implementation across nurses and found that while user resistance and usability are core issues to manage, doing so goes well beyond the user-technology interface and included system-related, user-related, and organizational factors. Hilty et al [31] state how we need to be more purposeful in designing technology that helps implement the Quadruple Aim goals such as clinician burnout and doing so requires a multilevel approach that targets multiple factors including clinical, human factors, training, professional development, and administrative workflows.…”

“…Many of the surveyed papers studied HOFs using specific technologies including mental health consultation [20,21], online consultations [22,32], clinical decision support systems (CDSS) [23], electronic medication management systems [24], video consultation [25][26], aged care systems [27] and telemedicine [36]. The context of use for these systems included hospitals [23,[28][29][30][31][32][33][34], residential aged care homes [27], and community health facilities [35]. Eleven papers were review papers and described a range of technology, users, and processes [20-22, 26-27, 31, 37-41].…”

“…Of significance is that these papers continue to highlight the importance of understanding the bigger system of processes, tasks and other system concepts that exist outside the user-technology interface. Barriers and facilitators to CDSS implementation included system-related, user-related, and organizational factors [23]. Individual-centered interventions are not enough, and they must be complemented with organizational focused interventions [23].…”

“…Barriers and facilitators to CDSS implementation included system-related, user-related, and organizational factors [23]. Individual-centered interventions are not enough, and they must be complemented with organizational focused interventions [23]. Harahap studied personal health record adoption in Indonesia and showed that while individual and technological factors impact PHR adoption, so do organizational factors [35].…”