Barriers and strategies in Implementing Clinical Decision Support System in Hospitals: A Case Study in Iran


Zahra Alighanbari 1 , Ali Alizadeh 2 , * , Farid Khorrami 3

1 College of Management,Bandar Abbas Branch,Islamic Azad University,Bandar Abbass,Iran.

2 Department of Health Education,Hormozgan University of Medical Sciences,Bandar Abbass,Iran.

3 Department of Health Information Technology,Hormozgan University of Medical Sciences,Bandar Abbass,Iran.

How to Cite: Alighanbari Z , Alizadeh A , Khorrami F . Barriers and strategies in Implementing Clinical Decision Support System in Hospitals: A Case Study in Iran, Hormozgan Med J. 2017 ; 21(2):e87286. doi: 10.29252/hmj.21.2.138.


Hormozgan Medical Journal: 21 (2); e87286
Published Online: August 21, 2017
Article Type: Research Article
Received: January 18, 2017
Accepted: August 21, 2017




Introduction: Most modern medical issues are inherently complicated and accurate
decisions are not always likely to be made based on logical reasons. Furthermore, the
huge volume of information relevant to a simple diagnostic area makes this decision
making even more troublesome. Hence, with the advent of technology, there is an ever
increasing need for the Clinical Decision Support System (CDSS) in hospitals. This study
has been conducted in an Iranian hospital with the aim of identifying the most significant
barriers for implementing CDSS and suggesting appropriate strategies to remove them.
Methods: This qualitative cross-sectional study was conducted in 2015. The sample
population of the study included 180 physicians and nurses in Shahid Mohammadi hospital
in Bandar Abbas whose performance was changed using CDSS. The participants were
selected using stratified sampling from 23 different wards in the hospital. First, the barriers
and strategies for implementation of CDSS in other countries were extracted from a review
study which was used to make a preliminary model. Then, the results of a questionnaire and
Delphi tests in three rounds were included in the final model.
Results: The most significant barriers in implementing CDSS were categorized into 6
groups according to the participants. These include barriers from human resources and
infrastructures as well as financial, technical, environmental and legal ones. The barriers for
them were divided into 5 categories including structural, technical, financial, human and
environmental ones.
Conclusion: Since the most significant obstacle in implementing CDSS in this hospital was
from humans, the hospital can use the barriers provided in 5 categories and better benefit
from the system. These barriers are training the human resources before they start working,
engaging them in implementation process of the CDSS and using evidence-based scientific
databases in CDSS while removing fundamental barriers to the system.


Decision Support System Clinical Information Systems Medical Informatics

© 2017, Hormozgan Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.



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