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Table 2 Recommendations for further investigation

From: Barriers and facilitators to the adoption of electronic clinical decision support systems: a qualitative interview study with UK general practitioners



Provenance and Transparency

Supply the CDSS alongside an accessible and signposted evidence-base

Threat to autonomy and skills

Include GPs in the development of the tool so it is aligned to their clinical needs and workflow and so that they can recommend it to their peers

Clear communication and management guidance

For any prediction given by the tool, provide an evidence-based management or care guideline for the clinician to follow

Supply visual communication aids, co-designed with patients, so that clinicians can communicate the outcome of the tool with their patients easily

Sensitivity to wider context

Only release a new tool widely when validation of accuracy, and study of unintended consequences, has occurred in real world settings

Consider and evaluate contextual effects on accuracy such as age, frailty, and multi-morbidity

Ensure balance of false positives to false negatives given by tool is appropriate for resource use and does not result in excess harm

User control and flexibility

Allow GP to maintain control, override or dismiss a tool

Ensure there is a provision to record wider context rationale for over-riding tool use

Integrate tool appropriately with EHR and ensure self-population from previously recorded data as much as possible


Consult with GPs on appropriate balance between having a self-generating pop-up or having a template which can be called up by the GP

Alert proliferation and fatigue

Consider the new tool in the context of all other tools within the system. Is this one really adding value?

Consider developing technologies which manage multiple tools or prioritise the most important alerts and suppress the rest

Consider a learning system which learns from the behaviour of GPs and accumulated evidence of the effectiveness of the different tools and alerts to adapt tools’ behaviour

Training and support

Label and signpost online training available for using the tool within the tool itself, e.g. a video showing how it works and how to get the most from it and personalise settings where appropriate

Sustainability: How expensive and adequate is the support for the tool and will it still be provided over time?