How to Facilitate Clinical Decision Support Software Adoption

By Liza Dzhezhora

No matter how advanced medicine gets, mortality from medical errors still exists. Luckily, clinicians have a powerful assistant—clinical decision support software (CDSS)—and this direction in hospital management software development is gaining momentum. According to Verified Market Research, by 2027, the CDSS market will hit $2.59 billion, growing at a compound annual growth rate of 11.9%.

Though the future looks bright, the present is far from positive. Providers are hesitant to deploy CDSS, fearing potential challenges. So what are they, and how can we prevent them? We’ll consider the matter below.

What is CDSS?

CDSS is a set of programmatic tools to extract data from patients’ electronic health records (EHR), healthcare customer relationship management software, and other sources, delivering the data to medical professionals for swifter clinical decision-making. CDSS facilitates a wide range of tasks, including diagnostics, disease management, and electronic record management.

One of CDSS’ top benefits is that it reduces human factors regarding drug selection. CDSS can automatically prevent medication errors that may lead to allergies, incorrect dosages, and drug confrontation. Other areas of CDSS application include preventive care and clinical trial preparation.

Potential challenges to CCDS adoption

CDSS deployment can pose several challenges, namely:

• Alert fatigue and burnout. While monitoring a patient in real time is a positive trend, excessive notifications from CDSS do more harm than good. Endless alerts of varying priorities can lead to fatigue and frustration, as well as burnout. According to a Stanford University School of Medicine study, the latter is the case for 35%–60% of clinicians working with CDSS.

• Overreliance on the system. As clinicians get used to validating, say, medical image analysis results through CDSS, they gain trust in the tool and may lose their critical eye for what it presents. Blind acceptance can be dangerous not only for patients but also for clinicians and their skills.
• Need for interoperability. CDSS is challenging to integrate with other hospitals or systems by default. Hence, if patients come from another location or medical facility, their records should be manually transferred to the system.

The potential drawbacks of CDSS implementation can put the need for this tool under serious consideration. Fortunately, these pitfalls are preventable through a well-grounded implementation and full-scale cooperation with clinicians.

The CDSS implementation strategy

CDSS is for medical professionals and operates in their clinical environment. Therefore, it’s only logical that a good implementation strategy starts with healthcare providers.

Tips for providers

CDSS deployment is an effort-intensive task, so a preliminary analysis of the clinical need is required. This means clinicians themselves should be interested in the tool instead of their organizations imposing it in a top-down fashion.

For example, South Omaha Medical Associates in Nebraska analyzed their hospital needs before CDSS implementation. That provider identified cardiovascular disease treatment as a weak link in care provision and centered CDSS on its improvement. As a result, they improved the relevant workflows and gained a 25% increase in patient visits.

Tips for health IT vendors

Sometimes IT experts work independently, prioritizing their expertise and not the goal of delivering a handy assistant for doctors. As a result, the final CDSS product lacks user-centricity, which leads to low adoption and underuse. Involving experienced medical professionals early in the development cycle can prevent a range of issues.

First, clinician involvement works to prevent fatigue, frustration, and burnout. CDSS developers should discuss the alerts and their importance with the end users and set up corresponding priorities. Another worthy effort is setting up alert personalization (i.e., tailoring alerts to doctors’ specializations).

Second, consultations with medical experts can help avoid overreliance on the system. It’s important to remember that CDSS is an assistant, not a decision-maker. Clinicians should still decide on care, with CDSS only providing enough data to facilitate a timely decision.

Appealing to a valid reference can also boost clinicians’ acceptance of CDSS. For example, suppose the system refers to an expert to validate its recommendation. In that case, doctors can treat CDSS with less distrust or hostility, as the recommendation comes from a fellow professional, not a machine.

Tips for IT and clinicians’ cooperation

Looking to highlight some perks of CDSS adoption, the researchers from the University of Adelaide launched a survey to rank those perks by popularity.

Ease of use came out as the most powerful facilitator (75%), but who is responsible for ensuring it? At first glance, the answer might seem to be CDSS developers. However, developers can’t know which features facilitate using the solution without user testing by the clinicians who will employ it in their work.

Users also ranked technical support, training, and participation reasonably high at all stages of the development process, and they all were products of cooperation. Hence, seamless collaboration among teams provides better adoption of CDSS in a clinical setting.

And yet, one point often goes missing from providers’ agendas: A successful CDSS deployment is not a one-time effort.

A never-ending journey

To keep the system up and running, providers and tech experts should ensure CDSS maintenance. This doesn’t just involve upgrading the system or its components. Knowledge bases and decision-support algorithms require maintenance, too.

Providers should keep those knowledge bases and algorithms up to date with relevant developments and clinical guidelines. Only medical professionals can do this efficiently. Consequently, the effort can add work to practitioners’ tight schedules or require hiring an expert with a medical background. It’s a tough choice: The former can hurt care provision, and the latter can strain providers’ budgets. Nevertheless, CDSS will likely deliver erroneous and harmful recommendations without regular knowledge base updates.

Summing up

To facilitate CDSS adoption, providers should select a medical specialty that could be central to CDSS deployment. When the choice is made, tech specialists should step in, while letting clinicians participate in CDSS development from the start. Knowing their professional area’s ins and outs, clinicians can help prevent pitfalls timely. All the teams participating in the solution’s development should help out when their expertise can benefit another party. It’s also important to remember that CDSS is dynamic—which means it requires regular updates, including updates for the knowledge base.

When a CDSS project follows a well-tuned strategy and all teams know what they are doing and why, the adoption is only a matter of time.

Liza Dzhezhora is a healthcare IT analyst at Itransition, a custom software development company headquartered in Denver. She looks into the ways IT technologies can streamline healthcare processes and explores how medical IoT, AI, robotics, and healthcare analytics help solve industry challenges.