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CDS must be used in order for it to have any meaningful impact on the health care parameters such as health care delivery, quality, safety and outcomes.

Usage of CDS is dependent on several factors that can be subcategorized into three broad areas:

i) CDS factors ii) User factors iii) Environmental factors

Some user factors are common to all user groups (physicians, nurses, and ancillary health care professionals); others may be more specific to physicians. One key factor influencing the use of CDS by physicians are the perceptions that they hold. Physician perceptions are a key factor in understanding physician uptake, usage and adherence of CDS.

The relation of perception to behavior is important because the ”…world as it is perceived is the world that is behaviorally important”(1). Factors informing perception fall into 3 areas: i) perceiver issues, ii) target issues and iii) situational issues.

Perceiver issues encompass concepts such as attributes, motives, interest, experiences and expectancies.

Target issues (in the context of CG/CDS) would encompass a) conceptual qualities of CDS e.g. is the CDS credible, believable, realistic, practical, user friendly, and b) functional qualities e.g. design of the user interface (sound and sights).

Situational issues (in the context of CDS) would encompass issues such as time pressure, workflow arrangements, ancillary, technical and infrastructural support, and patient clinical acuity.

Positive perceptions surrounding successful CDS implementation/use include:

i) a perception of an organizational culture of collaboration ii) trust and belief by physicians that CDS is under their control iii) that there is positive outcome expectancy.(2, 3)

Physicians perceive that CDS helps with organizing knowledge, can prevent overlapping work, and can supply educational reminders.(4) In addition, physicians perceive that CDS offers more patient specific advice at the point of care delivery, that guidelines/best practice are more up to date, and that CDS systems may have some user preferences that allow modification of the CG/advice delivered via CDS.

Negative perceptions center around:

i) negative effect on workflow (workflow interruption and disruption and intrusiveness) ii) usability flaws (speed, ease of use, lack of effective integration into CIS workflow) as well as excessive decision support, inappropriate decision support and CDS that is considered too intrusive iii) increased task duration. For example, physicians perceive that high levels of alerts are intrusive, disrupt workflow and, as a consequence the evidence suggests that high levels of alert overrides exist.(2)

In addition, negative physician perceptions include that CDS could threaten/harm the patient-doctor relationship, reduce the use of clinical perception or the “clinical eye”, create extra workload, offer erroneous reminders (based on wrong inputs e.g. out of date drug lists), and be a threat to physician’s autonomy and individual decision making.(4)


1) Robbins SP, Judge TA. Organizational Behavior. Upper Saddle River, NJ: Prentice Hall; 2011.

2) Byrne C, Sherry D, Mercincavage L, Johnston D, Pan E, Schiff G. Advancing Clinical Decision Support: Key Lessons In Clinical Decision Support Implementation. USA: Office of the National Coordinator for Health Information Technology, HHS, 2012 12/6/2012. Report No.: Department of Health and Human Services Contract # HHSP23320095649WC.

3) Sambasivan M, Esmaeilzadeh P, Kumar N, Nezakati H. Intention to adopt clinical decision support systems in a developing country: effect of physician's perceived professional autonomy, involvement and belief: a cross-sectional study. BMC medical informatics and decision making. 2012;12:142. PubMed PMID: 23216866. Pubmed Central PMCID: PMC3519751. Epub 2012/12/12. eng.

4) Varonen H, Kortteisto T, Kaila M. What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians. Family practice. 2008 Jun;25(3):162-7. PubMed PMID: 18504253. Epub 2008/05/28. eng.

Submitted by (Nigel Umar Beejay)