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|Title:||Exploring the Continuous Use of Knowledge-Based Clinical Decision Support Systems and Its Relationship with Knowledge Translation|
|Keywords:||CDSS;healthcare information systems;knowledge translation;Physicians' identity|
|Abstract:||In this study, the continuous use of knowledge-based clinical decision support systems (KB-CDSS) is examined. KB-CDSS not only provides advice to clinicians, but also integrates guidelines with patient information and provides clinicians with tools that facilitate the application of guidelines in patient care. Studying KB-CDSS as a continuous application is important because continuity is a prerequisite to the success of KB-CDSS implementations and is considered as an important motivator for knowledge translation. Previous research in the area of health information systems (HIS) use has focused on the acceptance of these systems through the use of mostly information systems related constructs. Therefore, the theoretical models that explain the use of HIS have been limited and they obfuscated other phases of HIS such as continuous use. Moreover, extant research has not, to a large extent, considered the influence of KB-CDSS use on knowledge translation, the application of clinical guidelines in practice. This study seeks to fill these gaps in the literature by first integrating context-related factors with IS factors. This supports the study of antecedents of continuous use of KB-CDSS systems, exploring the relationship between continuous use and knowledge translation, and exploring changes in system dynamics (how usage patterns change with time). In order to achieve these research objectives, a literature review of healthcare and IS research was conducted, resulting in a comprehensive theoretical model that explains the antecedents of continuous use and its relationship to knowledge translation. To validate this model, data were collected from different sources, including: A questionnaire deployed to 118 physicians using the McMaster Pain Assistant KB-CDSS in three academic clinics in South Western Ontario, followed by five focus groups to further explain the context of using the systems and antecedents of its use, and the analysis of system use through data obtained from system logs and patient charts. The findings of this study show that: (i) Threats to physician professional identity surpasses intention to continue using KB-CDSS, thus influencing its use by physicians in the first six months; (ii) The relationships between factors influencing continuous system use change with time; (iii) System use has a strong relationship with knowledge translation after 6 months of use, but this relationship diminishes after 12 months of use; and (iv) How patients are affected by the system positively influences physician satisfaction with the system and hence their use of the system. This study helps in explaining the theory of physicians’ continuous use of KB-CDSS and how the antecedents of use change with time. Methodologically, this study has discovered several techniques that can be used to improve HIS research and physician acceptance of IS methods. Finally, in practice this study presents several suggestions for improving the development and deployment of KB-CDSS to enhance its use during the knowledge translation process.|
|Appears in Collections:||Open Access Dissertations and Theses|
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