JMIR Publications

ABSTRACT

Background:

Electronic Clinical Decision Support Systems (eCDSSs) have been an integral component of the digital transformation in healthcare.

Objective:

This study aims to explore mental health clinician experience in screening for stroke risk among patients with atrial fibrillation and their perception of the potential impact of an eCDSS in improving care quality.

Methods:

A mixed method study, employing a questionnaire and individual semi-structured interviews, was conducted in a large London national health service trust. Interviews were analysed using an inductive thematic approach.

Results:

The sample comprised 10 clinicians. Two overarching themes related to prevention of AF-related stroke were identified from interviews: challenges faced on wards and strategies needed to improve practice. Challenges included difficulty identifying relevant medical histories of patients, clinician perceived lack of expertise, fragmented medical care, and mental health symptoms Suggestions to improve clinical practice included clinicians receiving alerts containing the latest guidelines and policies on stroke management, and bespoke training sessions designed to advance the knowledge, competencies and confidence of clinicians. As for the potential impact of an eCDSS in improving quality of care, two themes emerged: perceived benefits and perceived risks. Potential benefits included enhanced clinical effectiveness, saving time and improved outcomes. Reported perceived risks were rigidity in decision making, annoyance, and increased workload.

Conclusions:

A positive attitude towards an eCDSS to screen for stroke risk was identified although some concerns were noted. Understanding clinician perceptions of how an eCDSS may enhance health care and outcomes could serve as a basis for creating impactful digital health tools.