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 success	Interventions to improve performance
Actors in System	Task	Additional orders were needed to improve efficiency of order-entry time	Corollary orders created for each subspeciality to improve efficiency of transfer order-entry
	User	Heterogeneous cohort of surgical subspecialists Ordering providers rotate frequently	Custom order menus created for each speciality Training was embedded in resident orientation
	Technology	Orders needed to be tracked automatically No way to automatically capture contraindications	Unique prophylaxis order items built for tracking Created unique contraindication orders
Interfaces	Task 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