Implementing a clinical decision support system in an Aboriginal health service – A qualitative case study

Objective

This qualitative case study aims to evaluate the implementation of a clinical decision support system (CDSS) – Territory Kidney Care (TKC) – at an Aboriginal health service in the Northern Territory (NT) of Australia. This research aims to contribute understandings about the challenges clinicians face when navigating electronic systems within an Aboriginal health service setting and enablers and barriers to the implementation of CDSS.

Methods

Within a larger evaluation of TKC, this qualitative case study involved 13 baseline semi-structured interviews completed between October 2022 and January 2023 and seven follow up interviews conducted in June 2023. Through purposive sampling, clinicians in a range of primary care roles participated in the study. Interview transcripts were inductively and iteratively coded by two researchers using a thematic analysis approach.

Results

The baseline evaluation found that clinicians working in an Aboriginal health service used multiple electronic health systems, spent considerable time collating patient data across systems and faced challenges related to missing information, technological issues and limited training. The process evaluation of TKC implementation identified that adequate training, a funded Implementation Officer role and supportive leadership were central enablers, while competing clinical priorities, time limitations, staff shortages, access processes were key barriers to uptake and usage.

Conclusions

This case study highlights the need for integrated data tools in Aboriginal health services to bridge the gaps between primary, tertiary, government and non-government services. The evaluation emphasises the importance of embedding CDSS within workflows and ensuring there are dedicated staff and resources to facilitate implementation.

Lay Summary

This study focuses on how a clinical decision support system was implemented in an Aboriginal health service in the Northern Territory of Australia. Through interviews with clinicians, we identify key barriers and enablers to accessing clinical decision support, as an adjunct to electronic health records. Clinicians in Aboriginal health services must use multiple systems and spend a lot of time looking for information about their patients; a new integrated data platform called Territory Kidney Care was implemented to pull information together from different health services. This research highlights the importance of ensuring there are dedicated staff and resources to help implement new systems.