Table 2 Framework of barriers to using CDSSs
Knowledge-related barriers |
     -   1.  Knowledge regarding the (specific functions of the) CDSS |
               o     Knowledge of basic functions |
               o     Knowledge of user personalization functions |
Barriers related to the evaluation of the features of the CDSS |
     -   2. Source and content of the CDSS |
               o     Reliability of the source of the content |
               o     Currentness of the content |
               o     Relevance of the alert content for different user groups |
               o     Relevance of the alert content for individual users, with varying needs across time |
     -   3. Format/lay out of the CDSS content |
               o     Notification method of alerts (too intrusive or uninformative) |
               o     Readability of the alert text (too wordy/verbose) |
     -   4. Functionality of the CDSS |
               o     Responsiveness of the system (loading of an alert takes too long) |
               o     Intensity of alerts (low threshold for triggering alerts) |
               o     Flexibility (lack of adjustability to personal preferences) |
               o     Learning capacity of the system (only fixed rules are used) |
External barriers interacting with the CDSS |
     -   5. Patient-related factors |
               o     Doctor-patient communication (too much time spent on the computer during consultation) |
               o     Relevance of alert content for patient (discrepancy between patient’s reason for visit and alert content) |
     -     6. Environmental factors |
               o     Limited time available (during and after consultation) |
               o     Too much additional work required (during and after consultation) |
               o     Lack of integration with other systems (no direct links to follow-up actions) |
               o     Fear for misuse of data (patient data and medical practice) by third parties (i.e. health insurers) |