Table 4 Impeding factors for implementation of DSS due to HOT-fit domains

Technology: system quality

Access/interoperability

Difficult access to DSS

[29, 39]

Not compatible with existing systems → double documentation

[38, 39]

Usability/functions

Complicated data entry methods

[30]

Alerts are not visible

[29]

No notification when data has been updated (e.g. new lab results)

[39]

Data entry insufficiently checked regarding completeness and correctness

[30]

Flexibility/interactivity

DSS not adjustable to individual conditions and complex patient cases

[27, 28, 30]

DSS does not provide a holistic approach of the patient cases

[34]

Technology: information quality

Evidence

Recommendations are strictly drawn

[32]

Completeness

Incomplete information (e.g. regarding local resistance patterns)

[39]

Relevancy

Insecurity because of irrelevant and too much information and options

[30, 33

Organization: structure

Technical support

Insufficient support regarding technical concerns and questions

27]

Technical equipment

Insufficient number of computers and workstations

[27, 28]

Multipliers

Lacking support from management level or multipliers

[28]

Training courses

Lack of training courses

[27]

Internal communication/feedback

Lacking knowledge of availability and advantages of DSS

[29]

Hierarchy/standards

Standards of the unit or team, which are seen as unchangeable and not compatible with new innovations

[28, 34, 35]

Influence of senior physicians attitude/senior physicians as decision-making authorities

[28, 30, 38]

Organization: environment

Statutory framework

Questions regarding responsibility in medication errors due to DSS use is not regulated by law clearly

[40]

User: satisfaction

Perceived gain

Lack of satisfaction, since there is no perceived gain or benefit

[27, 30]

User: system use

Attitude/opinion

Negative attitude towards technology

[27, 36]

Resistancy/reservation towards changes

[40]

Experience/familiarity

Lack of experience with DSS

[27, 28, 33, 40]

Knowledge/competencies

Idea of not having enough technological competencies for using DSS

[40]

Lack of knowledge regarding the functions and advantages of DSS

[27, 29]

Advantages of DSS are seen sceptical of users with more professional experience

[27, 28, 34]

Net benefits

Time

Use of DSS is seen as more time consuming

[27, 38, 40]

Workflow

Use of DSS means the changeover of work processes

[27, 28, 30, 32, 37, 39, 40]

Job autonomy/professional role

Physicians tend to rely on DSS only

[40]

Use of DSS is perceived as an intervention in professional autonomy

[27, 32, 36, 40]