Table 6 Recommendations for practice and research

1. Recommendations for practice

 a. Clinical context factors

  • Implement CDS with the goal of enhancing clinical processes (e.g. structured chronic disease care) rather than replacing clinical judgment with “blanket recommendations”

  • Use CDS to trigger discussions, but recognise that consultation priority should be set by patients and clinicians

 b. User factors

  • Ensure users are familiar with the CDS – what it can do and how to use it – through initial training and follow-up sessions

  • Help users to see where CDS can assist them, rather than see the CDS as an unwelcome, competing authority

 c. External context

  • Design CDS appropriate for existing workflows to save time and avoid extra work

  • At the service-level, structure a team of key clinician leaders and allocated personnel who will support CDS implementation and ongoing use

 d. Technical

  • Utilise user experience (UX) principals to design visually attractive and easy to use user interfaces (e.g. less is more, avoid alert overload)

  • Integrate CDS with existing EHR in real time to minimise laborious data entry

2. Recommendations for research

 • Healthcare providers are frustrated with the current generation of simplistic, often single chronic disease focussed CDS tools. Future research can explore how CDS design and workflow can be better built for multimorbidity – this should include multiple perspectives from clinicians, informaticians, and software developers on what is feasible and how to achieve it.

 • CDS assists rather than replaces the complexity of human clinician decisions. Therefore, even with advances in technology, CDS is likely to remain “imperfect” from the user’s perspective. Future CDS implementation research can explore strategies to explicitly address user expectations, and identify user-led solutions to optimise the clinical utility of imperfect CDS technology.

 • CDS projects may stall post-implementation and after research team support is withdrawn. More health service-level research needs to be conducted to explore optimal financial reimbursement policies to sustain CDS uptake in routine clinical settings.