ArticleInternational journal of medical informatics2011
Barriers and facilitators to the use of computer-based intensive insulin therapy.
Article in International journal of medical informatics, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 39 citations in OpenAlex.
- Use of Simulation to Study Nurses' Acceptance and Nonacceptance of Clinical Decision Support Suggestions.Computers, informatics, nursing : CIN · 2015Trial
- Nurse-led glycemic control protocols in intensive care units: a scoping review.Acute and critical care · 2026Article
- A systematic review of clinicians' acceptance and use of clinical decision support systems over time.NPJ digital medicine · 2025Article
- Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: a NASSS framework-informed scoping review.Implementation science : IS · 2023Article
- Artificial Intelligence Applications in Health Care Practice: Scoping Review.Journal of medical Internet research · 2022Article
- A Scoping Review of Integrated Medical Devices and Clinical Decision Support in the Acute Care Setting.Applied clinical informatics · 2022Article
- Barriers and Facilitators to Implementation of Medication Decision Support Systems in Electronic Medical Records: Mixed Methods Approach Based on Structural Equation Modeling and Qualitative Analysis.JMIR medical informatics · 2020Article
- Timing of Insulin with Meals in the Hospital: a Systems Improvement Approach.Current diabetes reports · 2019Review
- Acceptability of Clinical Decision Support Interface Prototypes for a Nursing Electronic Health Record to Facilitate Supportive Care Outcomes.International journal of nursing knowledge · 2018Article
- Informatics Solutions for Application of Decision-Making Skills.Critical care nursing clinics of North America · 2018Review
- Integrative review of clinical decision support for registered nurses in acute care settings.Journal of the American Medical Informatics Association : JAMIA · 2017Review
- Review of Social and Organizational Issues in Health Information Technology.Healthcare informatics research · 2015Review
- Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations.BMC medical informatics and decision making · 2015Article
- Using a sociotechnical framework to understand adaptations in health IT implementation.International journal of medical informatics · 2013Article
- The future is now: software-guided intensive insulin therapy in the critically ill.Journal of diabetes science and technology · 2013Review
- Review
- Toward Meaningful Care Plan Clinical Decision Support: Feasibility and Effects of a Simulated Pilot Study.Nursing researchArticle
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
purposeComputerized clinical decision support systems (CDSSs) for intensive insulin therapy (IIT) are increasingly common. However, recent studies question IIT's safety and mortality benefit. Researchers have identified factors influencing IIT performance, but little is known about how workflow affects computer-based IIT. We used ethnographic methods to evaluate IIT CDSS with respect to other clinical information systems and care processes.
methodsWe conducted direct observation of and unstructured interviews with nurses using IIT CDSS in the surgical and trauma intensive care units at an academic medical center. We observed 49h of intensive care unit workflow including 49 instances of nurses using IIT CDSS embedded in a provider order entry system. Observations focused on the interaction of people, process, and technology. By analyzing qualitative field note data through an inductive approach, we identified barriers and facilitators to IIT CDSS use.
resultsBarriers included (1) workload tradeoffs between computer system use and direct patient care, especially related to electronic nursing documentation, (2) lack of IIT CDSS protocol reminders, (3) inaccurate user interface design assumptions, and (4) potential for error in operating medical devices. Facilitators included (1) nurse trust in IIT CDSS combined with clinical judgment, (2) nurse resilience, and (3) paper serving as an intermediary between patient bedside and IIT CDSS.
conclusionThis analysis revealed sociotechnical interactions affecting IIT CDSS that previous studies have not addressed. These issues may influence protocol performance at other institutions. Findings have implications for IIT CDSS user interface design and alerts, and may contribute to nascent general CDSS theory.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.