The DOI matches its Crossref record; 81 of the 81 references it cites were found in a registry or an index; none of the 39 sources its claims cite is checked for support yet.
Computerized clinical decision support for prescribing: provision does not guarantee uptake
Open accessAbstract
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.
Overview
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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.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Organizational factors (table 3)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“consistently that limited computer availability at the point of care impeded CDSS use.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Organizational factors (table 3)
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > CDSS features (table 2)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Technical assistance to address hardware and software issues was often limited.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Organizational factors (table 3)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Organizational factors (table 3)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 50 studies focusing on a specific CDSS, 38 systems used prompts, such as alerts or reminders, within the computerized order entry system or electronic medical record.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > CDSS features (table 2)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found no difference in the outcomes so we report our analysis according to the classification described above.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Analysis and reporting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the overwhelming consistency in our findings when we compared themes across different time periods and settings, we first report our overall findings according to domain and then highlight pertinent issues that emerged when we compared themes by time and setting.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Barriers to and facilitators of CDSS uptake
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“On the other hand, systems where end-users had difficulty switching between displays or requiring backtracking were less likely to be adopted.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Specific issues related to CDSSs (table 6)
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Further, we established a notable consistency in CDSS-specific issues over time.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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.
- Probably not a substantial claim. 35
- It may state two separate claims as one. 20
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Study characteristics (table 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > CDSS features (table 2)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twenty-nine studies focused solely on the opinions or behaviors of physicians.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Study characteristics (table 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Study characteristics (table 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Study characteristics (table 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 174 potentially relevant articles, 58 studies 1 2 16 18-74 were included in the review.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Studies identified (figure 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Study characteristics (table 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > CDSS features (table 2)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Provider-related factors (table 4)
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Importantly, CDSS tools were seen to be beneficial for providing physicians with reminders about patient safety and long-term management.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Specific issues related to CDSSs (table 6)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Further, financial incentives for clinicians, as well as having adequate funds to support the introduction of the CDSS, were reported to facilitate uptake.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Organizational factors (table 3)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Provider-related factors (table 4)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Interestingly, the earlier studies highlighted concerns about professional liability and patient privacy in relation to the use of CDSSs.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- 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.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Provider-related factors (table 4)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“As a consequence, providers felt they may become desensitized to alerts and miss important information.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Specific issues related to CDSSs (table 6)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Patient-related factors (table 5)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There was a range of views expressed about the benefits of CDSS within the consultation and its influence on the patientdoctor interaction.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Patient-related factors (table 5)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, patient-related factors were mostly reported in studies conducted within ambulatory care settings and in studies conducted since 2000.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Comparison of themes across different time periods and settings
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
What the sources say
- Not checked yetcites [19] Shah, 2006, Improving acceptance of computerized prescribing alerts in ambulatory care, J Am Med Inform Assoc source
- Not checked yetcites [20] Sittig, 2006, A survey of factors affecting clinician acceptance of clinical decision support, BMC Med Inform Decis Mak source
- Not checked yetcites [30] Campbell, 2006, Types of unintended consequences related to computerized provider order entry, J Am Med Inform Assoc source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Patient-related factors (table 5)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Comparison of themes across different time periods and settings
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The importance of CDSS content, particularly its relevance to individual patients, was a recurring theme.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Specific issues related to CDSSs (table 6)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Provider-related factors (table 4)
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Key concerns relate to the usability of the system and relevance of the content.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Not surprisingly, ease of use (eg, quick access, minimal mouse clicks and key strokes), simplicity and visibility of messages were key drivers of use.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Specific issues related to CDSSs (table 6)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Information-dense messages with inconsistent vocabulary and the requirement to re-enter patient data to generate advice were also deterrents to use.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Specific issues related to CDSSs (table 6)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The verbatim extracts were reviewed independently by pairs of reviewers (AM and IH, AM and SP)”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Analysis and reporting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Abstract
What the sources say
- Not checked yetcites [12] Kawamoto, 2005, Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success, BMJ source
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Analysis and reporting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Reviewers reached consensus around the interpretation of findings via group discussion.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Analysis and reporting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data extraction was undertaken independently by two reviewers (AM and IH).”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Data extraction
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A third reviewer (SP) assessed a sample of studies to validate the extraction method and clarify any disagreements between the primary data extractors.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Data extraction
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the variety of study designs, we did not formally assess the quality of the individual studies in this review.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Study characteristics (table 1)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > Abstract
What the sources say
- Not checked yetcites [5] Walton, 2001, Computerised advice on drug dosage to improve prescribing practice, Cochrane Database Syst Rev
- Not checked yetcites [6] Durieux, 2008, Computerized advice on drug dosage to improve prescribing practice, Cochrane Database Syst Rev source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
What the sources say
- Not checked yetcites [20] Sittig, 2006, A survey of factors affecting clinician acceptance of clinical decision support, BMC Med Inform Decis Mak source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The limited information available in many of the published manuscripts precluded stratifying results by specific CDSS features.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
What the sources say
- Not checked yetcites [76] Doumit, 2007, Local opinion leaders: effects on professional practice and health care outcomes, Cochrane Database Syst Rev
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Importantly, these data may not necessarily indicate the significance of a particular issue.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
What the sources say
- Not checked yetcites [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 yetcites [4] Kuperman, 2007, Medication-related clinical decision support in computerized provider order entry systems: a review, J Am Med Inform Assoc source
- Not checked yetcites [75] Miller, 2005, Clinical decision support and electronic prescribing systems: a time for responsible thought and action, J Am Med Inform Assoc source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
What the sources say
- Not checked yetcites [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 yetcites [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
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
What the sources say
- Not checked yetcites [75] Miller, 2005, Clinical decision support and electronic prescribing systems: a time for responsible thought and action, J Am Med Inform Assoc source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our review studies were heterogeneous in terms of design and data collection methods so we did not conduct comprehensive quality assessment of individual reports.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized clinical decision support for prescribing: provision does not guarantee uptake > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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.”
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?
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
MinorThe figure reports 59 studies, but its accompanying text says the review reported 58.
“Studies reported (n=59)*”
“Thus 58 studies, from 60 manuscripts, were reported in the review.”
Retrieved-article count differs between the figure and results
MinorThe figure reports 175 articles retrieved for detailed evaluation, while the results section says there were 174 potentially relevant articles.
“Articles retrieved for a more detailed evaluation (n=175)”
“Of 174 potentially relevant articles, 58 studies 1 2 16 18-74 were included in the review.”
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Rahmner, P. B., Karlsson, E., Arnhjort, T., Eliasson, M., Gustafsson, L. L., Jacobsson, L., Ovesjö, M., Rosenqvist, U., Sjöviker, S., Tomson, G. B., et al. (2004) · International Journal of Health Care Quality Assurance · doi:10.1108/09526860410541487 · Cited by 25
Efficiency and safety of chemotherapy plans for children: CATIPO—a nationwide approach
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Clinicians' Response to Computerized Detection of Infections
Rocha, B. H., Christenson, J. C., Evans, R. S., & Gardner, R. M. (2001) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2001.0080117 · Cited by 21
Design and evaluation of a computer reminder system to improve prescribing behaviour of GPs.
Martens, J. D., van der Aa, A., Panis, B., van der Weijden, T., Winkens, R. A. G., & Severens, J. L. (2006) · PubMed · Cited by 19
Information management and reading habits of German diabetologists: a questionnaire survey
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Closing the loop of patient care--a clinical trial of a computerized discharge medication program.
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The design and evaluation of clinical decision support systems in the area of pharmacokinetics
Hwang, H., Chang, I.-C., Hung, W.-F., Sung, M., & Yen, D. C. (2004) · Medical Informatics and the Internet in Medicine · doi:10.1080/14639230400009158 · Cited by 11
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Flagged first, then by citations
Research works printed but not linked: 1
- Sowerby Centre for Health Informatics at Newcastle (SCHIN), 1998, PRODIGY phase one summary report. R-38
Cited by
Sorted by citations
The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview
Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., McKinstry, B., Procter, R., Majeed, A., & Sheikh, A. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1000387 · Cited by 1,442
Ross, J., Stevenson, F., Lau, R., & Murray, E. (2016) · Implementation Science · doi:10.1186/s13012-016-0510-7 · Cited by 1,011
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Liberati, E. G., Ruggiero, F., Galuppo, L., Gorli, M., González-Lorenzo, M., Maraldi, M., Ruggieri, P., Polo Friz, H., Scaratti, G., Kwag, K. H., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0644-2 · Cited by 301
Kilsdonk, E., Peute, L., & Jaspers, M. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.12.001 · Cited by 303
Metadata
- 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
- 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
- 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
- hybrid
- doi.org
- 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.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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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