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Cited by 305Electronic Health Records SystemsArtificial Intelligence in Healthcare and EducationTechnology and Human Factors in Education and Health

Computerized clinical decision support for prescribing: provision does not guarantee uptake

Open access
Moxey, Annette, Robertson, Jane, Newby, David, Hains, Isla, Williamson, Margaret, Pearson, Sallie-Anne·2010·Journal of the American Medical Informatics Association
DOI 10.1197/jamia.m3170PMC PMC2995634
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Abstract

There is wide variability in the use and adoption of recommendations generated by computerized clinical decision support systems (CDSSs) despite the benefits they may bring to clinical practice. We conducted a systematic review to explore the barriers to, and facilitators of, CDSS uptake by physicians to guide prescribing decisions. We identified 58 studies by searching electronic databases (1990-2007). Factors impacting on CDSS use included: the availability of hardware, technical support and training; integration of the system into workflows; and the relevance and timeliness of the clinical messages. Further, systems that were endorsed by colleagues, minimized perceived threats to professional autonomy, and did not compromise doctor-patient interactions were accepted by users. Despite advances in technology and CDSS sophistication, most factors were consistently reported over time and across ambulatory and institutional settings. Such factors must be addressed when deploying CDSSs so that improvements in uptake, practice and patient outcomes may be achieved.

Verified 2026-10-06 · 20 references not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 58 studies found that making computerized prescribing decision support available does not ensure clinicians use it; uptake depends on organizational, provider, patient, and system-specific factors. Barriers and facilitators were largely stable across time and settings, with workflow integration, technical support, training, message relevance and timing, and autonomy concerns recurring.

Key findings

  • Across 58 studies from 60 manuscripts (1990–2007), factors affecting CDSS use spanned infrastructure and access, technical problems, implementation support, integration, endorsement, roles, liability and privacy; provider knowledge, training, and autonomy; patient characteristics and doctor–patient interaction; and CDSS usability, content, and prompt timing. Up to 96% of alerts may be overridden or ignored.
  • Most included studies examined a specific CDSS (50/58), were conducted since 2000 (43), took place in ambulatory care (38), and were from North America (35); 29 focused only on physicians. Common clinical areas were cardiovascular disease (12), respiratory conditions (5), and antibiotic prescribing (5); 19 focused on drug alerts.
  • Among 50 specific-system studies, 38 used prompts, 33 were integrated with existing software, 28 were system-initiated, and 35 gave assessment plus treatment recommendations. Ease of use, simple and visible messages, workflow fit, and relevant and timely content facilitated use; dense messages, re-entering data, poor timing, and excessive alerts hindered it.
  • Time and setting comparisons showed endorsement and financial incentives mainly in post-2000 studies; earlier studies raised liability and privacy concerns while later ones noted risk mitigation; ambulatory studies more often reported technical support, integration, and patient-related factors; CDSS-specific issues were consistent over time and settings.

Methods

  • Systematic review of peer-reviewed literature; searched Medline, PreMedline, Embase, CINAHL, PsycINFO, INSPEC, Cochrane Database of Systematic Reviews, and hand-searched reference lists; English-language studies from 1990 to 2007.
  • Included studies if they examined electronic decision support or evidence-based information for prescribing, primarily targeted physicians, and reported primary data on barriers or facilitators; editorials and speculation were excluded. 58 studies from 60 manuscripts were included.
  • Data extraction was done by two reviewers with third-reviewer validation; thematic analysis used four domains—organizational, provider, patient, and CDSS-specific—overall and stratified by study period (1990–1999 vs 2000–2007) and setting (ambulatory vs institutional).

Limitations

  • Stated: possible missed studies not in the public domain or outside peer-reviewed literature; heterogeneous designs meant no comprehensive quality assessment; time periods were arbitrary and year of conduct was imputed when missing; the framework may not capture interplay or relative importance; frequency counts do not indicate importance; limited reporting precluded stratifying by specific CDSS features.
  • Evident: many included studies relied on self-reported opinions and experiences; no formal quality appraisal was performed; publication and reporting biases are possible; findings describe barriers and facilitators rather than causal effects on uptake or patient outcomes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1197/jamia.m3170

Cites

62 of 82 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 39 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    CDSS use was compromised when the software could not be integrated with existing systems.

    “Studies also reported that CDSS use was compromised if the software itself could not be integrated with existing systems, and the roles and responsibilities of end users were not clearly delineated during the implementation phase (eg, who would be responsible for managing the clinical issues relating to an alert).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Limited computer availability at the point of care hindered CDSS use.

    “consistently that limited computer availability at the point of care impeded CDSS use.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Most systems provided an assessment plus specific treatment recommendations.

    “The majority of studies reported on systems that were integrated with existing software programs (n533), were system-initiated (n528) and provided an assessment and specific recommendations for treatment (n535).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Technical assistance for hardware and software problems was often limited.

    “Technical assistance to address hardware and software issues was often limited.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Even when workstations were accessible, technical problems such as malfunctions, system failures, and slow speeds were barriers to CDSS use.

    “Further, even when computer workstations were accessible, clinicians identified ongoing technical problems such as malfunctions, system failures and slow computer speeds as barriers to use.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 35
  • May combine two claims. 20

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most included studies examined clinicians' opinions of a specific CDSS.

    “Most studies explored clinicians' opinions of a specific CDSS (n550); were classified as being conducted since 2000 (n543); were conducted within ambulatory care (n538); and were undertaken in North America (n535).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most systems were integrated with existing software programs.

    “The majority of studies reported on systems that were integrated with existing software programs (n533), were system-initiated (n528) and provided an assessment and specific recommendations for treatment (n535).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-nine studies focused only on physicians' opinions or behaviors.

    “Twenty-nine studies focused solely on the opinions or behaviors of physicians.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most included studies were conducted in ambulatory care.

    “Most studies explored clinicians' opinions of a specific CDSS (n550); were classified as being conducted since 2000 (n543); were conducted within ambulatory care (n538); and were undertaken in North America (n535).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most included studies were conducted since 2000.

    “Most studies explored clinicians' opinions of a specific CDSS (n550); were classified as being conducted since 2000 (n543); were conducted within ambulatory care (n538); and were undertaken in North America (n535).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The review included 58 studies.

    “Of 174 potentially relevant articles, 58 studies 1 2 16 18-74 were included in the review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most included studies were conducted in North America.

    “Most studies explored clinicians' opinions of a specific CDSS (n550); were classified as being conducted since 2000 (n543); were conducted within ambulatory care (n538); and were undertaken in North America (n535).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most systems were system-initiated.

    “The majority of studies reported on systems that were integrated with existing software programs (n533), were system-initiated (n528) and provided an assessment and specific recommendations for treatment (n535).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Clinicians wanted more computer training but also worried that up-skilling could de-skill clinical decision making and lead to over-dependence on technology.

    “Clinicians emphasized the need for further computer training, but also highlighted a concern that up-skilling in this domain may lead to de-skilling in clinical decision making, resulting in over-dependence on technology.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    CDSS tools were seen as beneficial for reminding physicians about patient safety and long-term management.

    “Importantly, CDSS tools were seen to be beneficial for providing physicians with reminders about patient safety and long-term management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Financial incentives for clinicians and adequate funding to introduce the CDSS facilitated uptake.

    “Further, financial incentives for clinicians, as well as having adequate funds to support the introduction of the CDSS, were reported to facilitate uptake.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Lack of training in CDSS use and limited computer skills among clinicians were repeatedly identified as significant barriers.

    “The lack of training in the use of CDSSs and the limited computer skills of clinicians were flagged repeatedly as a significant barrier to use.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Earlier studies highlighted concerns about professional liability and patient privacy in relation to CDSS use.

    “Interestingly, the earlier studies highlighted concerns about professional liability and patient privacy in relation to the use of CDSSs.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Year of study conduct more accurately captures changes over time in factors influencing CDSS uptake than publication year does.

  • May combine two claims.

    Findingreasoning

    Key issues for CDSS uptake include hardware availability and access, technical support and training, integration into clinical workflow, and the relevance and timeliness of clinical messages.

    “Fundamental issues include the availability and accessibility of hardware, sufficient technical support and training in the use of the system, the level of system integration into clinical workflow and the relevance and timeliness of the clinical messages provided.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    These barriers reduced providers' confidence and sometimes caused anxiety about using CDSS at the point of care.

    “These impacted on providers' confidence in using the systems, and in some cases, clinicians reported anxiety about using the CDSS at the point of care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Patient factors were a key feature of ambulatory-care studies and effectively absent from institutional-care studies.

    “Further, the influence of patient factors was a key feature of studies conducted in ambulatory care and effectively absent from studies conducted in institutional care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Providers felt they might become desensitized to alerts and miss important information.

    “As a consequence, providers felt they may become desensitized to alerts and miss important information.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Clinicians may accept drug allergy alerts for patients considered truly allergic but override the same alert for patients who had tolerated the medication previously.

    “For example, clinicians may accept drug allergy alerts in patients considered truly allergic, yet override the same alert in patients who had tolerated the medication in the past.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    There was a range of views about whether CDSS benefits consultation and affects the patient-doctor interaction.

    “There was a range of views expressed about the benefits of CDSS within the consultation and its influence on the patientdoctor interaction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patient-related factors were mostly reported in ambulatory-care studies and in studies conducted since 2000.

    “In addition, patient-related factors were mostly reported in studies conducted within ambulatory care settings and in studies conducted since 2000.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Year of study conduct more accurately captures changes over time in factors influencing CDSS uptake than publication year does.

  • May combine two claims.

    Findingcitation

    Some CDSSs are highly sophisticated, well developed, and extensively evaluated, but they tend to come from a small number of internationally recognized medical informatics institutions.

    “Some CDSSs are highly sophisticated, well developed and evaluated extensively, however they tend to come from a small number of institutions recognized internationally for their work in medical informatics.19 20 30 32 33 44 -46 66”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [19] Shah, 2006, Improving acceptance of computerized prescribing alerts in ambulatory care, J Am Med Inform Assoc source

      Not checked in the free run.

    • cites [20] Sittig, 2006, A survey of factors affecting clinician acceptance of clinical decision support, BMC Med Inform Decis Mak source

      Not checked in the free run.

    • cites [30] Campbell, 2006, Types of unintended consequences related to computerized provider order entry, J Am Med Inform Assoc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingreasoning

    Some clinicians felt CDSS enhanced dialogue with patients, while others felt it detracted from the interaction, for example by reducing eye contact.

    “In some studies, clinicians felt it enhanced dialog with their patients, whereas in others, CDSS was seen to detract from the patient interaction (eg, loss of eye contact).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Ambulatory-care studies identified lack of day-to-day technical support and limited CDSS integration with existing software as important barriers to uptake.

    “Studies evaluating the impact of CDSSs for prescribing in ambulatory care highlighted a lack of technical support addressing day-to-day software and hardware issues and limited integration of CDSS with existing software as important barriers to uptake.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Ambulatory-care studies tended to report the need for technical assistance with hardware and software and highlighted minimal CDSS use when software was not integrated with existing systems.

    “Studies conducted in ambulatory care tended to report the need for technical assistance in relation to hardware and software issues and highlighted the minimal use of CDSS if software was not integrated with existing systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Stakeholder acceptance, clear endorsement of patient-care benefits, and reducing perceived threats to professional autonomy are important for CDSS success.

    “Further, acceptance of the system by the various stakeholders (eg, management and end users), clear articulation and endorsement of the system's benefits in patient care, and minimizing the perceived threats to professional autonomy are important to the success of CDSSs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The relevance of CDSS content to individual patients was a recurring theme.

    “The importance of CDSS content, particularly its relevance to individual patients, was a recurring theme.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Such systems resulted in better prescribing practices.

    “Conversely, other studies indicated that a CDSS was more likely to be used when clinicians believed it enhanced decision making, and that such systems resulted in better prescribing practices.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The main concerns for CDSS use are system usability and content relevance.

    “Key concerns relate to the usability of the system and relevance of the content.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Ease of use, simplicity, and visibility of messages were key drivers of CDSS use.

    “Not surprisingly, ease of use (eg, quick access, minimal mouse clicks and key strokes), simplicity and visibility of messages were key drivers of use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Information-dense messages, inconsistent vocabulary, and the need to re-enter patient data were deterrents to CDSS use.

    “Information-dense messages with inconsistent vocabulary and the requirement to re-enter patient data to generate advice were also deterrents to use.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Verbatim extracts were reviewed independently by pairs of reviewers.

    “The verbatim extracts were reviewed independently by pairs of reviewers (AM and IH, AM and SP)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Providing specific treatment recommendations or advice is superior to giving only a problem assessment that requires further consideration.

    “Despite these limitations, some reviews have demonstrated the benefits of computer-over paper-based decision support, 12 system-over user-initiated tools, 10 11 and integrated over stand-alone systems, 10 and the advantage of providing specific treatment recommendations or advice rather than a simple problem assessment requiring further consideration by end users.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Kawamoto, 2005, Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A sensitivity analysis was run with and without the 17 studies that lacked year of conduct.

    “To ensure that these assumptions did not impact on study findings, we conducted the time-based analysis with and without the inclusion of the 17 studies that did not report year of study conduct.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Reviewers reached consensus on interpretation through group discussion.

    “Reviewers reached consensus around the interpretation of findings via group discussion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data extraction was performed independently by two reviewers.

    “Data extraction was undertaken independently by two reviewers (AM and IH).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A third reviewer checked a sample of studies to validate the extraction method and resolve disagreements between the primary extractors.

    “A third reviewer (SP) assessed a sample of studies to validate the extraction method and clarify any disagreements between the primary data extractors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The review did not formally assess the quality of individual studies.

    “Given the variety of study designs, we did not formally assess the quality of the individual studies in this review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Using CDSSs for prescribing can lower toxic drug levels and shorten time to therapeutic control.

    “Systematic reviews have demonstrated that use of CDSSs for prescribing can reduce toxic drug levels and time to therapeutic control, 5 6 reduce medication errors 7 8 and change prescribing in accordance with guideline recommendations.9”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Walton, 2001, Computerised advice on drug dosage to improve prescribing practice, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [6] Durieux, 2008, Computerized advice on drug dosage to improve prescribing practice, Cochrane Database Syst Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The organizational framework used may not reflect the interplay among factors, and the review did not map interrelationships or infer relative importance.

    “We used an organizational framework adapted from previous research 20 that may not necessarily reflect the level of interplay between the various factors, and we did not attempt to map these interrelationships or infer their relative importance.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Sittig, 2006, A survey of factors affecting clinician acceptance of clinical decision support, BMC Med Inform Decis Mak source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Limited information in many published manuscripts prevented stratification of results by specific CDSS features.

    “The limited information available in many of the published manuscripts precluded stratifying results by specific CDSS features.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Integration problems may be equally important in institutional settings but are more easily addressed in hospitals with high computerization.

    “However, these issues may be equally important in institutional settings, just more easily addressed in hospitals where there are high levels of computerization for managing patient administration and a range of aspects of clinical care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many interventions aimed at changing physician behavior use endorsement and promotion by respected peer group members as a fundamental implementation strategy.

    “While many interventions targeting physician behavior change use endorsement and promotion by respected peer group members as a fundamental component of their implementation strategy, 76 this may not have been seen as a key driver for change in the early studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Doumit, 2007, Local opinion leaders: effects on professional practice and health care outcomes, Cochrane Database Syst Rev

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The frequency with which studies reported specific domains, themes, and subthemes may not indicate the significance of a particular issue.

    “Importantly, these data may not necessarily indicate the significance of a particular issue.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Endorsement may not have been viewed as a key driver for change in early studies.

    “While many interventions targeting physician behavior change use endorsement and promotion by respected peer group members as a fundamental component of their implementation strategy, 76 this may not have been seen as a key driver for change in the early studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The review's key findings from a diverse literature support the opinions and recommendations of leading figures about successful CDSS implementation.

    “Importantly, our key findings, generated from a diverse literature, support the opinions and recommendations of luminaries in the field who have written extensively about the key requirements for successful implementation of CDSS in clinical practice.3 4 75 78”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] Miller, 2005, The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt, J Biomed Inform source

      Not checked in the free run.

    • cites [4] Kuperman, 2007, Medication-related clinical decision support in computerized provider order entry systems: a review, J Am Med Inform Assoc source

      Not checked in the free run.

    • cites [75] Miller, 2005, Clinical decision support and electronic prescribing systems: a time for responsible thought and action, J Am Med Inform Assoc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Previous systematic reviews showed that CDSSs are more effective in hospital than ambulatory care and for acute rather than chronic conditions.

    “Previous systematic reviews have demonstrated the greater effectiveness of CDSSs in hospital compared with ambulatory care 10 and for the management of acute rather than chronic conditions.13”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Pearson, 2009, Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007), BMC Health Serv Res source

      Not checked in the free run.

    • cites [13] Sintchenko, 2007, Are we measuring the right end-points? Variables that affect the impact of computerised decision support on patient outcomes: a systematic review, Med Inform Internet Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review may not have identified all relevant studies because some may not be publicly available or may be outside peer-reviewed literature.

    “Despite our intensive efforts we may not have identified all relevant studies as some may not be available in the public domain, and others may be published outside the peer-reviewed academic literature.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Greater acceptance of technology and efforts by organizations such as AMIA likely dispelled some early concerns about liability and privacy.

    “However, greater acceptance of the technology on the part of end-users and the efforts of organizations such as the American Medical Informatics Association in overseeing and endorsing the introduction of guidelines and regulations 75 is likely to have dispelled some of the early concerns.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Miller, 2005, Clinical decision support and electronic prescribing systems: a time for responsible thought and action, J Am Med Inform Assoc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The review did not conduct comprehensive quality assessment of individual reports because the included studies were heterogeneous in design and data collection methods.

    “Our review studies were heterogeneous in terms of design and data collection methods so we did not conduct comprehensive quality assessment of individual reports.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The review's strengths include systematic study identification, inclusion of various study designs, capturing CDSS features beyond content and functionality, and stratifying analysis by time period and setting.

    “The strengths of this study lie in the systematic approach to identifying studies, the inclusion of a range of study designs, our attempts to capture CDSS features beyond content and functionality, and the stratification of our analysis by the time period in which the studies were conducted and the setting in which they were undertaken.”
    Quote in the paperNot a substantial claim
50 of 50

  • The authors state this as an assumption.

    Year of study conduct more accurately captures changes over time in factors influencing CDSS uptake than publication year does.

    “Although time periods were defined somewhat arbitrarily, we believed that year of study conduct would more accurately capture any changes in the factors influencing CDSS uptake over time.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Physician resistance to e-health implementation is related to fear of, dissatisfaction with, and uncertainty over new roles and responsibilities created by the introduction of e-health systems.

    “Physician resistance to e-health implementation is reported by several studies to be related to fear of [18], dissatisfaction with [18] and uncertainty over [43, 47] new roles and responsibilities, created by the introduction of e-health systems [18].”

    From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [43]

  • Leadership engagement at all stages of development and implementation can help improve effective implementation of e-health systems.

    “Leadership engagement at all stages of the development and implementation processes can help improve the effective implementation of e-health systems [43, 54, 56, 58]”

    From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [43]

  • Negative perceptions included beliefs that electronic systems would disrupt care delivery, doubts that systems can improve patient care/clinical outcomes/quality of medical practices, distrust in systems, and general staff resistance to change.

    “Negative perceptions included beliefs that electronic systems would disrupt the delivery of care [49]; doubts that these systems can improve patient care, clinical outcomes or improve the quality of medical practices [43]; and distrust in the systems [37] as well as a more general staff resistance to change [28, 32, 39, 41, 49, 51–53].”

    From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [43]

  • Training and financial incentives were cited as strategies to overcome skill-related barriers.

    “Training [25, 37, 43] and financial incentives [37] were cited as strategies to overcome skill-related barriers.”

    From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [43]

  • The work of planning includes delineation of roles and responsibilities, securing time for system selection and procurement, evaluating concomitant policy and process changes, needs assessment and analysis, development of a business plan, early identification and engagement of champions, involving end users, establishing a guiding philosophy, testing organisational readiness, development of incent

    “The work of planning includes the delineation of roles and responsibilities [43], securing time to invest system selection and procurement [18], evaluating other concomitant policy and process changes [40], needs assessment and analysis, development of a business plan [44], early identification and engagement of champions [31], involving end users [16, 27, 41, 51], establishing a guiding”

    From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [43]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Final study count differs between the figure and its caption

    Minor

    The figure reports 59 studies, but its accompanying text says the review reported 58.

  • Retrieved-article count differs between the figure and results

    Minor

    The figure reports 175 articles retrieved for detailed evaluation, while the results section says there were 174 potentially relevant articles.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Sowerby Centre for Health Informatics at Newcastle (SCHIN), 1998, PRODIGY phase one summary report. R-38

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Related

Authors
Moxey, A., Robertson, J., Newby, D., Hains, I., Williamson, M., & Pearson, S.-A.
Affiliations
  • University of Newcastle Australia (AU)
  • UNSW Sydney (AU)
Corresponding author
Pearson, Sallie-Anne
ORCID
Venue
Journal of the American Medical Informatics Association
Publisher
Oxford University Press (OUP)
Published
2010-01
Volume
17
Issue
1
Pages
25-33
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
DOI
10.1197/jamia.m3170
PMC
PMC2995634
OpenAlex
W2148284486
Semantic Scholar
ac814743bd8252d3b4c1778923ff3cd25b6ef663
Cited by
305
References
81
Citations by year
2026: 10 · 2025: 17 · 2024: 20 · 2023: 30 · 2022: 28 · 2021: 22 · 2020: 22 · 2019: 16 · 2018: 15 · 2017: 16 · 2016: 19 · 2015: 26 · 2014: 11 · 2013: 21 · 2012: 14
FWCI
2.40
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Journal of the American Medical Informatics Association (publishedVersion, public-domain)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
University of New South Wales
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
Keywords
computerized clinical decision support, drug prescribing, technology adoption, barriers to adoption, adoption facilitators, physician acceptance, clinical workflow integration, clinical alerts, professional autonomy, doctor-patient interaction
MeSH terms
Drug Therapy, Computer-Assisted, Humans, Practice Patterns, Physicians', Drug Prescriptions, Decision Support Systems, Clinical

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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