Table 3.

Themes that emerged in comments when asked about non-financial barriers to implementing clinical decision support (n=52)

Theme/category identified	Example of narrative provided by the respondent
Physician buy-in/engagement is important for the success of any change.	“MDs sitting down setting individual pt thresholds (if need be) and then all MD sticking to these as they rotate on and off service.”
Concerns about being able to trust the accuracy of only electronic data exchange.	“Team members reluctance to rely solely on electronic communication”
Support from top administrators is lacking.	“Lack of understanding on the part of organization administrators that may not understand the need for or value of technology.”
Changes in workflow are a barrier.	“changes in workflow”
Readiness of the whole system is required in order to adopt any new electronic processes.	“Do not have a fully implemented EMR, still using a fairly manua system.”
The challenges of integrating data from all sources are significant.	“Multiple computer systems within our own organization that have tremendous difficulty interfacing with each other.”
Resistance to change or inertia is everywhere.	“systems already in place, comfort level with current workflow, computer giving a suggestion that physician may not agree with”
Backload existing data would require significant extra work.	“Anything that requires duplication of data entry”; “People to perform entry of the backload of patients who would need to be entered into a tracking database.”
The system is too complex to lend itself to any CDS (patients and processes vary all of the time).	“insufficient complexity of CDS to account for patient-specific needs”
The cost or financial investment is substantial.	“It always seems as though there is a financial barrier!”