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Open Access Highly Accessed Research article

Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients

Arjen E de Vries1*, Martje HL van der Wal1, Maurice MW Nieuwenhuis1, Richard M de Jong1, Rene B van Dijk2, Tiny Jaarsma3, Hans L Hillege1 and Rene J Jorna4

Author Affiliations

1 Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, Groningen, 9700 RB, The Netherlands

2 Department of Cardiology, Martini Hospital, Groningen, Groningen, The Netherlands

3 Department of Social- and Welfare Studies, Linköping University, Faculty of Health Sciences, Norrköping, Sweden

4 Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands

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BMC Medical Informatics and Decision Making 2013, 13:54  doi:10.1186/1472-6947-13-54

Published: 26 April 2013



Clinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).


A questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.


The response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).


Both cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.