Table 1

Sociotechnical issues identified by the team during CDS implementation and interventions taken to improve performance. Findings are categorised using the FITT framework (adapted from Ammenwerth et al8)

Issues or barriers to CDS successInterventions to improve performance
Actors in SystemTask
  • Additional orders were needed to improve efficiency of order-entry time

  • Corollary orders created for each subspeciality to improve efficiency of transfer order-entry

  • Heterogeneous cohort of surgical subspecialists

  • Ordering providers rotate frequently

  • Custom order menus created for each speciality

  • Training was embedded in resident orientation

  • Orders needed to be tracked automatically

  • No way to automatically capture contraindications

  • Unique prophylaxis order items built for tracking

  • Created unique contraindication orders

InterfacesTask Technology
  • Surgeons used unexpected order menu pathways

  • Orders embedded in deep in sets were overlooked

  • Obsolete pathways removed from the order menus

  • Prophylaxis orders placed at start of pathway

User technology
  • Risk categories were difficult to apply to patients

  • Decision support content difficult to interpret

  • Prophylaxis options organised by procedure

  • Content updated according to user feedback

User task
  • Guidelines discordant with local practice

  • Providers unwilling to use enoxaparin or heparin

  • Clinical champions engaged to in-service trainees

  • New warfarin order process developed with anticoagulation clinic