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CC BY 4.0 · Appl Clin Inform 2025; 16(04): 777-785
DOI: 10.1055/a-2581-6236
Special Issue on CDS Failures

Opportunities and Challenges Associated with the Pilot Implementation of Clinical Decision Support Systems in a Rural Hospital: A Qualitative Study

Authors

  • Nicki Newton

    1   Digital Health Human Factors Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

  • Adeola Bamgboje-Ayodele

    1   Digital Health Human Factors Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

  • Rowena Forsyth

    2   Department of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

  • Lenert Bruce

    3   NSW Health, Wagga Wagga, Murrumbidgee Local Health District, New South Wales, Australia

  • Steven M. McPhail

    4   Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia

  • Tim Shaw

    2   Department of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

  • Sundresan Naicker

    4   Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia

  • Amina Tariq

    4   Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia

  • Melissa T. Baysari

    1   Digital Health Human Factors Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

Funding This research was supported by Digital Health CRC Limited (“DHCRC”). DHCRC is funded under the Australian Commonwealth's Cooperative Research Centres (CRC) Program. The funder played no role in study design, data collection, analysis and interpretation of data, or the writing of this manuscript.
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Abstract

Background

Despite their potential, Clinical Decision Support (CDS) systems often lack alignment with clinicians' needs and are underutilized in practice. Pilot implementations can help to improve the fit between systems and local needs by engaging users in real-world testing and refinement. Although pilot implementations of CDS have been reported, limited evidence has explored the factors contributing to pilot success.

Objectives

This study aimed to explore the opportunities and challenges associated with the pilot implementation of a CDS system that ultimately did not progress to full-scale implementation.

Methods

We conducted interviews with clinicians, health service managers, and vendors involved in the pilot implementation and use of a mobile application-based CDS, and a dashboard-based CDS in two departments (Emergency and Patient Flow) of a rural Australian hospital. A semistructured interview guide was developed using the Non-adoption, Abandonment, Sustainability, Scale-up, and Spread (NASSS) framework. Interviews were audio-recorded, transcribed, and thematically analyzed.

Results

Analysis revealed four major themes: system performance and design, implementation processes, organizational support and resources, and perceived benefits of the CDS. The pilot implementation allowed for greater user input into the iterative design of CDS in practice, particularly in the Emergency Department (ED), where clinicians had both the capacity and willingness to engage. However, technical issues encountered early in the pilot deterred many users who did not re-engage even after issues were resolved. Although some users remained engaged, they became frustrated as organizational resource constraints meant that critical issues impacting the CDS's clinical utility went unresolved.

Conclusion

Successful CDS pilots depend on the readiness of organizations, departments, and users to engage in pilot activities. Pilot implementations should be pursued in settings where users have both the capacity and willingness to participate in iterative feedback processes and where organizations have sufficient resources to address emerging needs.

Keywords

clinical decision support systems - pilot projects - hospitals - attitude of health personnel - human-centered design

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Sydney Local Health District Ethics Review Committee (#2021/STE04111).


Supplementary Material



Publication History

Received: 16 December 2024

Accepted: 10 April 2025

Accepted Manuscript online:
11 April 2025

Article published online:
14 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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