JMIR Publications

ABSTRACT

Background:

Computerized clinical decision support systems (CDSS) are essential components of modern health system service delivery, particularly within acute care settings like hospitals. Theories, models, and frameworks may assist in facilitating implementation processes associated with CDSS innovation and use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals.

Objective:

This scoping review identified the theory, model, or framework approaches that have been used to facilitate the implementation and adoption of CDSS in tertiary healthcare settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described.

Methods:

Five electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsychINFO, and EMBASE) to identify studies that implemented or adopted a CDSS in a tertiary healthcare setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the ‘Active Implementation Framework stages’: exploration (feasibility and organizational readiness); installation (organizational preparation); initial implementation (initiating implementation, i.e., training); full implementation (sustainment) and non-translational effectiveness studies.

Results:

Eighty-one records (n=42 full text, n=39 abstracts) were included. Full-text studies and abstracts are separately reported. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently utilized to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list limitations associated with applying a specific theory, model, or framework.

Conclusions:

Models and related quality improvement methods, were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. Findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSS.