Expanding usability analysis with intrinsic motivation concepts to learn about CDSS adoption: a case study

• Intrinsic motivation plays an important role in the use of CDSS among MDs.
• Positive indicators for computer-based support include comfort with technology and low effort.
• Negative indicators are perceived lack of competence and tension from lack of prior experience.
• Limited adoption of CDSS may be partly explained by lack of intrinsic motivation to use computers.
• Observations call for increased training in computer support in general and not just specific CDSS.

ObjectivesDespite many clinical decision support systems (CDSSs) being rated as highly usable, CDSSs have not been widely adopted in clinical practice. We posit that there are factors aside from usability that impact adoption of CDSSs; in particular we are interested in the role played by MDs intrinsic motivation to use computer-based support. Our research aim is to investigate the relationship between usability and intrinsic motivation in order to learn about adoption of CDSS in clinical practice.MethodsFollowing the evaluation of a CDSS, 19 MDs completed a 2 part questionnaire about their intrinsic motivation to use computer-based support in general and the usability of the evaluated CDSS.ResultsThe analysis of MDs motivation to use computer-based support demonstrated that MDs are comfortable using computer-based support and in general find using it quite easy (a motivation rating of 0.66 on a (0, 1) scale was computed). However MDs also reported a perceived lack of competence associated with a lack of prior experience using technology in practice, which results in pressure and tension. The considered CDSS scored highly on all usability dimensions and a usability rating of 0.74 was recorded. The examination of the relationship between motivation and usability suggested that users who were motivated to use computer-based support experienced better usability than those who reported low levels of motivation.ConclusionsOur small case study suggests that an important factor supplementing the usability of CDSSs is intrinsic motivation to use computer-based support in general. We posit that the lack of such a measure thus far in CDSS evaluation may to some extent explain seeming MD satisfaction with CDSSs on one hand, but their limited adoption on the other. We recommend that clinical managers responsible for deploying CDSS should invest in training MDs to use technology underlying computer-based support applications instead of focusing only on the features of the specific CDSS to be deployed.