Recommendations for the implementation of Clinical Decision Support Systems

Design & development teams

Integrate CDSS with existing Electronic Health Record (EHR) and IT systems

• Ensure data security
• Update technology automatically
• Work with clinical software companies to ensure complete, error-free integration

Align CDSS with current practice and complex workflow

• Ensure CDSS is efficient, flexible and timesaving
• Integrate patient facing and primary care team components along the primary care pathway to enable easy documentation and monitoring
• Build CDSS for complex interrupted workflows

Ensure front-end usability by developing simple, intuitive and attractive CDSS

• Use consistent, appealing and high-quality graphic displays with good structure and visualisation, familiar format and clear wording
• Create a simple navigation through few screens that hides redundant information and uses auto-population of fields
• Provide passive, non-intrusive prompts with acceptable frequency that are easy to address
• Show results as clear, objective, quantitative percentage score with interpretation aids adjusted to users’ levels of education and skills

Support adaptability

• Provide technical FAQs within the system
• Address technical challenges to improve functionality
• Update with new guidelines and IT changes

Design CDSS for appropriate diagnostic challenges

• Select conditions that are challenging to diagnose and manage in every-day primary care
• Align CDSS with existing evidence-based clinical guidelines
• Consider using CDSS to support professional skills development and clinical judgement (e.g., in LMICs)

Engage stakeholders early and throughout the developmental process

• Include institutional leaders, frontline healthcare workers, community partners, local opinion leaders
• Align CDSS with PCPs’ and patients’ expectations and requirements, including when and how to use CDSS

Test and evaluate CDSS adequately prior to implementation

• Evaluate the accuracy of underlying risk model, feasibility in clinical practice, effectiveness for patient outcomes, and cost-effectiveness

Communicate the value of CDSS for patient and providers and actively address concerns

• Emphasise value and positive examples for:
  – Complex/ borderline decision-making
  – Workload and optimisation of the diagnostic process
• Emphasise value for quality of patient care (e.g., more effective management and shared decision-making, better prevention)
• Inform PCPs about patients’ support for use of CDSS, if combined with professional consultation
• Address concerns regarding CDSS output, technical issues, AI/ machine learning and data security, and perceptions of CDSS being a professional threat

Primary care teams

Clarify team responsibilities

• Explicitly agree roles and responsibilities regarding the CDSS with the whole practice team (and patients where applicable)
• Assign a practice CDSS champion to manage expectations and support implementation
• Create an open and supportive organisational culture

Engage and support patients

• Ensure training that is interactive and accessible with a practical element of how to use CDSS
• Promote education about specific condition and management/ guidelines
• Support users to develop a routine when first implementing CDSS

Provide training for healthcare professionals

• Be aware of potential stigma around conditions (e.g., mental health)
• Be mindful of patients’ health literacy and computer skills
• Consider including patient education resources alongside CDSS

Commissioners & policymakers

• Specify and deliver a collaborative strategy to incorporate sustainable digital solutions in healthcare systems, including governance and quality control mechanisms
• Provide guidance on use of evidence-based CDSS in clinical guidelines to endorse use
• Clarify liability and medicolegal practice prior to implementation (e.g., non-adherence, algorithm and human errors)
• Provide adequate funding for staff and the development, integration, and maintenance of CDSS and functioning IT systems