TY - JOUR
T1 - Barriers to implementation of a computerized decision support system for depression
T2 - An observational report on lessons learned in "real world" clinical settings
AU - Trivedi, Madhukar H.
AU - Daly, Ella J.
AU - Kern, Janet K.
AU - Grannemann, Bruce D.
AU - Sunderajan, Prabha
AU - Claassen, Cynthia A.
N1 - Funding Information:
This work was supported by the National Institute of Mental Health grant 1-R01-MH064062-01A2, "Computerized Decision Support System for Depression (CDSS-D)", Madhukar H. Trivedi, M.D., PI; by the Substance Abuse and Mental Health Services Administration grant 1 H79 SM56021-01, "Beta Testing a Computerized Version of the Texas Medication Algorithm for Serious Mental Illness at Community MHMR", Madhukar H. Trivedi, M.D., PI; by the Substance Abuse and Mental Health Services Administration grant 1-H79-SM54577-01, "CompTMAP", Madhukar H. Trivedi, M.D., PI; We also wish to acknowledge the Harris County and Tarrant County Mental Health and Mental Retardation (MHMR) clinics.
PY - 2009
Y1 - 2009
N2 - Background. Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources) for the change and strategies to implement and maintain new systems. Methods. To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D) in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners) participated across five sites, accruing over 300 outpatient visits on 168 patients. Results. Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping. Conclusion. The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.
AB - Background. Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources) for the change and strategies to implement and maintain new systems. Methods. To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D) in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners) participated across five sites, accruing over 300 outpatient visits on 168 patients. Results. Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping. Conclusion. The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.
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U2 - 10.1186/1472-6947-9-6
DO - 10.1186/1472-6947-9-6
M3 - Article
C2 - 19159458
AN - SCOPUS:60349093262
SN - 1472-6947
VL - 9
JO - BMC Medical Informatics and Decision Making
JF - BMC Medical Informatics and Decision Making
IS - 1
M1 - 6
ER -