A six-year repeated evaluation of computerized clinical decision support system user acceptability

• Published in: International journal of medical informatics (Shannon, Ireland) Vol. 112; pp. 74 - 81
• Main Authors: Grout, Randall W., Cheng, Erika R., Carroll, Aaron E., Bauer, Nerissa S., Downs, Stephen M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-04-2018
• Subjects: Computerized decision support system; Decision support; Quality improvement; User acceptability; User satisfaction; TAM; PSF; Quality improvement; CHICA; User satisfaction; Computerized decision support system; User acceptability; PWS; CDSS; EHR; Decision support
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2018.01.011

•User acceptability can affect CDDS efficacy, but only short-term data are known.•Computerized CDSS users completed surveys repeated five times over six years.•Frequent users and clinical providers had more favorable opinions of the CDSS.•CDSS user acceptability improves with time, user experience and system abilities.•Broad and sustainable user acceptability is possible with computerized CDSS.
Long-term acceptability among computerized clinical decision support system (CDSS) users in pediatrics is unknown. We examine user acceptance patterns over six years of our continuous computerized CDSS integration and updates.
Users of Child Health Improvement through Computer Automation (CHICA), a CDSS integrated into clinical workflows and used in several urban pediatric community clinics, completed annual surveys including 11 questions covering user acceptability. We compared responses across years within a single healthcare system and between two healthcare systems. We used logistic regression to assess the odds of a favorable response to each question by survey year, clinic role, part-time status, and frequency of CHICA use.
Data came from 380 completed surveys between 2011 and 2016. Responses were significantly more favorable for all but one measure by 2016 (OR range 2.90–12.17, all p < 0.01). Increasing system maturity was associated with improved perceived function of CHICA (OR range 4.24–7.58, p < 0.03). User familiarity was positively associated with perceived CDSS function (OR range 3.44–8.17, p < 0.05) and usability (OR range 9.71–15.89, p < 0.01) opinions.
We present a long-term, repeated follow-up of user acceptability of a CDSS. Favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers. CHICA acceptability increased as it matured and users become more familiar with it. System quality improvement, user support, and patience are important in achieving wide-ranging, sustainable acceptance of CDSS.