A Conceptual Framework to Study the Implementation of Clinical Decision Support Systems (BEAR): Literature Review and Concept Mapping

• Published in: Journal of medical Internet research Vol. 22; no. 8; p. e18388
• Main Authors: Camacho, Jhon, Zanoletti-Mannello, Manuela, Landis-Lewis, Zach, Kane-Gill, Sandra L, Boyce, Richard D
• Format: Journal Article
• Language: English
• Published: Canada Gunther Eysenbach MD MPH, Associate Professor 06.08.2020; JMIR Publications
• Subjects: Acceptance; Algorithms; Behavior; Behavior change; Change agents; Clinical decision making; Clinical medicine; Concept mapping; Contingencies; Decision support systems; Decision Support Systems, Clinical - standards; Demography; Emotions; Female; Humans; Implementation; Influence; Intervention; Literature reviews; Male; Mapping; Medical personnel; Multimedia; Original Paper; Pharmacists; Practitioner patient relationship; Professionals; Roles; Science and technology; Social skills; Systematic review; Treatment preferences; clinical decision support system; determinants; barriers; facilitators; decision support system; technology acceptance; computerized decision support system; implementation science
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/18388

The implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance. Our objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs. We employed an iterative process to map constructs from four contributing frameworks-the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)-and the findings of 10 literature reviews, identified through a systematic review of reviews approach. The resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient-health professional relationship; patient's preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects. We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models.