Madhukar H. Trivedi|Ella Daly|Janet K. Kern|Bruce D. Grannemann|Prabha Sunderajan|Cynthia A. Claassen
Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings
The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center
despite wide promotion clinical practice guidelines limited effect changing physician behavior effective implementation strategies date included multifaceted interventions involving audit feedback local consensus processes marketing reminder systems either manual computerized interactive educational meetings addition growing evidence contextual factors affecting implementation must addressed organizational support leadership procedures resources change strategies implement maintain new systemsto examine feasibility effectiveness implementation computerized decision support system depression cdssd routine public mental health care texas fifteen study clinicians thirteen physicians two advanced nurse practitioners participated across five sites accruing 300 outpatient visits 168 patientsissues regarding computer literacy hardwaresoftware requirements identified initial barriers clinicians also reported concerns negative impact workflow potential need duplication transition paper electronic systems medical record keepingthe following narrative report based observations obtained initial testing use cdssd clinical settings emphasizes importance taking account organizational factors planning implementation evidencebased guidelines decision support within system