The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews

Esther R C Janssen; Jesper Knoop; Gianmatteo Farabolini; Nicoló Baldini; Thomas Hoogeboom; Maria Gabriella Ceravolo; Stefano Negrini; Carlotte Kiekens

doi:10.1093/jamia/ocag080

The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews

Esther R C Janssen^*
, Jesper Knoop
, Gianmatteo Farabolini
, Nicoló Baldini
, Thomas Hoogeboom
, Maria Gabriella Ceravolo
, Stefano Negrini
, Carlotte Kiekens
,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Despite the significant potential for Clinical Decision Support Systems (CDSSs) to improve care processes and health outcomes, several barriers hinder their widespread implementation in healthcare. While numerous systematic reviews have summarized potential barriers and facilitators for CDSS implementation, a comprehensive framework to guide and evaluate the implementation of CDSSs in healthcare is lacking. This overview of reviews, aims to establish a framework-GUIDE-CDSS-aimed at guiding and evaluating implementation of CDSSs in healthcare.

MATERIALS AND METHODS: An overview of systematic and scoping reviews was conducted by searching 6 databases. Systematic reviews or scoping reviews that used qualitative research methods to described implementation determinants for CDSSs in the healthcare domain were included. The AMSTAR 2 tool was used to assess the methodological quality. Results were collated into the GUIDE-CDSS framework. This framework describes implementation determinants and elements within those determinants found to impact implementation of CDSSs in healthcare.

RESULTS: Twenty-three reviews were included in the analysis. All reviews had at least 2 critical weaknesses, showing a limited methodological quality of included reviews. Eight determinants and 38 elements for implementation of CDSSs in healthcare and were described in the GUIDE-CDSS framework: perceived relevance, perceived effect, trustworthiness, ease of use, workflow, training and skills, resources, and implementation strategy.

DISCUSSION AND CONCLUSION: This overview provides a comprehensive synthesis of the determinants influencing the implementation of CDSSs in healthcare, collated in the GUIDE-CDSS framework. The findings underscore that for successful CDSS development, implementation and evaluation is multifactorial.

PROTOCOL REGISTRATION: This study was registered in PROSPERO (No. CRD42024512455).

Original language	English
Pages (from-to)	1811-1821
Journal	Journal of the American Medical Informatics Association
Volume	33
Issue number	9
Early online date	11 Jun 2026
DOIs	https://doi.org/10.1093/jamia/ocag080
Publication status	Published - 1 Sept 2026

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10.1093/jamia/ocag080Licence: CC BY

ocag080Final published version, 1.24 MBLicence: CC BY

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Janssen, E. R. C., Knoop, J., Farabolini, G., Baldini, N., Hoogeboom, T., Ceravolo, M. G., Negrini, S., Kiekens, C. (2026). The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews. Journal of the American Medical Informatics Association, 33(9), 1811-1821. https://doi.org/10.1093/jamia/ocag080

@article{e8266114527143ef8ac0bc70cc9e93da,

title = "The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews",

abstract = "OBJECTIVES: Despite the significant potential for Clinical Decision Support Systems (CDSSs) to improve care processes and health outcomes, several barriers hinder their widespread implementation in healthcare. While numerous systematic reviews have summarized potential barriers and facilitators for CDSS implementation, a comprehensive framework to guide and evaluate the implementation of CDSSs in healthcare is lacking. This overview of reviews, aims to establish a framework-GUIDE-CDSS-aimed at guiding and evaluating implementation of CDSSs in healthcare.MATERIALS AND METHODS: An overview of systematic and scoping reviews was conducted by searching 6 databases. Systematic reviews or scoping reviews that used qualitative research methods to described implementation determinants for CDSSs in the healthcare domain were included. The AMSTAR 2 tool was used to assess the methodological quality. Results were collated into the GUIDE-CDSS framework. This framework describes implementation determinants and elements within those determinants found to impact implementation of CDSSs in healthcare.RESULTS: Twenty-three reviews were included in the analysis. All reviews had at least 2 critical weaknesses, showing a limited methodological quality of included reviews. Eight determinants and 38 elements for implementation of CDSSs in healthcare and were described in the GUIDE-CDSS framework: perceived relevance, perceived effect, trustworthiness, ease of use, workflow, training and skills, resources, and implementation strategy.DISCUSSION AND CONCLUSION: This overview provides a comprehensive synthesis of the determinants influencing the implementation of CDSSs in healthcare, collated in the GUIDE-CDSS framework. The findings underscore that for successful CDSS development, implementation and evaluation is multifactorial.PROTOCOL REGISTRATION: This study was registered in PROSPERO (No. CRD42024512455).",

author = "Janssen, \{Esther R C\} and Jesper Knoop and Gianmatteo Farabolini and Nicol{\'o} Baldini and Thomas Hoogeboom and Ceravolo, \{Maria Gabriella\} and Stefano Negrini and Carlotte Kiekens",

note = "{\textcopyright} The Author(s) 2026. Published by Oxford University Press on behalf of the American Medical Informatics Association.",

year = "2026",

month = sep,

day = "1",

doi = "10.1093/jamia/ocag080",

language = "English",

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Janssen, ERC, Knoop, J, Farabolini, G, Baldini, N, Hoogeboom, T, Ceravolo, MG, Negrini, S, Kiekens, C 2026, 'The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews', Journal of the American Medical Informatics Association, vol. 33, no. 9, pp. 1811-1821. https://doi.org/10.1093/jamia/ocag080

The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews. / Janssen, Esther R C; Knoop, Jesper; Farabolini, Gianmatteo et al.
In: Journal of the American Medical Informatics Association, Vol. 33, No. 9, 01.09.2026, p. 1811-1821.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The GUIDE-CDSS framework

T2 - a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews

AU - Janssen, Esther R C

AU - Knoop, Jesper

AU - Farabolini, Gianmatteo

AU - Baldini, Nicoló

AU - Hoogeboom, Thomas

AU - Ceravolo, Maria Gabriella

AU - Negrini, Stefano

AU - Kiekens, Carlotte

N1 - © The Author(s) 2026. Published by Oxford University Press on behalf of the American Medical Informatics Association.

PY - 2026/9/1

Y1 - 2026/9/1

N2 - OBJECTIVES: Despite the significant potential for Clinical Decision Support Systems (CDSSs) to improve care processes and health outcomes, several barriers hinder their widespread implementation in healthcare. While numerous systematic reviews have summarized potential barriers and facilitators for CDSS implementation, a comprehensive framework to guide and evaluate the implementation of CDSSs in healthcare is lacking. This overview of reviews, aims to establish a framework-GUIDE-CDSS-aimed at guiding and evaluating implementation of CDSSs in healthcare.MATERIALS AND METHODS: An overview of systematic and scoping reviews was conducted by searching 6 databases. Systematic reviews or scoping reviews that used qualitative research methods to described implementation determinants for CDSSs in the healthcare domain were included. The AMSTAR 2 tool was used to assess the methodological quality. Results were collated into the GUIDE-CDSS framework. This framework describes implementation determinants and elements within those determinants found to impact implementation of CDSSs in healthcare.RESULTS: Twenty-three reviews were included in the analysis. All reviews had at least 2 critical weaknesses, showing a limited methodological quality of included reviews. Eight determinants and 38 elements for implementation of CDSSs in healthcare and were described in the GUIDE-CDSS framework: perceived relevance, perceived effect, trustworthiness, ease of use, workflow, training and skills, resources, and implementation strategy.DISCUSSION AND CONCLUSION: This overview provides a comprehensive synthesis of the determinants influencing the implementation of CDSSs in healthcare, collated in the GUIDE-CDSS framework. The findings underscore that for successful CDSS development, implementation and evaluation is multifactorial.PROTOCOL REGISTRATION: This study was registered in PROSPERO (No. CRD42024512455).

AB - OBJECTIVES: Despite the significant potential for Clinical Decision Support Systems (CDSSs) to improve care processes and health outcomes, several barriers hinder their widespread implementation in healthcare. While numerous systematic reviews have summarized potential barriers and facilitators for CDSS implementation, a comprehensive framework to guide and evaluate the implementation of CDSSs in healthcare is lacking. This overview of reviews, aims to establish a framework-GUIDE-CDSS-aimed at guiding and evaluating implementation of CDSSs in healthcare.MATERIALS AND METHODS: An overview of systematic and scoping reviews was conducted by searching 6 databases. Systematic reviews or scoping reviews that used qualitative research methods to described implementation determinants for CDSSs in the healthcare domain were included. The AMSTAR 2 tool was used to assess the methodological quality. Results were collated into the GUIDE-CDSS framework. This framework describes implementation determinants and elements within those determinants found to impact implementation of CDSSs in healthcare.RESULTS: Twenty-three reviews were included in the analysis. All reviews had at least 2 critical weaknesses, showing a limited methodological quality of included reviews. Eight determinants and 38 elements for implementation of CDSSs in healthcare and were described in the GUIDE-CDSS framework: perceived relevance, perceived effect, trustworthiness, ease of use, workflow, training and skills, resources, and implementation strategy.DISCUSSION AND CONCLUSION: This overview provides a comprehensive synthesis of the determinants influencing the implementation of CDSSs in healthcare, collated in the GUIDE-CDSS framework. The findings underscore that for successful CDSS development, implementation and evaluation is multifactorial.PROTOCOL REGISTRATION: This study was registered in PROSPERO (No. CRD42024512455).

U2 - 10.1093/jamia/ocag080

DO - 10.1093/jamia/ocag080

M3 - Article

C2 - 42281367

SN - 1067-5027

VL - 33

SP - 1811

EP - 1821

JO - Journal of the American Medical Informatics Association

JF - Journal of the American Medical Informatics Association

IS - 9

ER -

Janssen ERC, Knoop J, Farabolini G, Baldini N, Hoogeboom T, Ceravolo MG et al. The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews. Journal of the American Medical Informatics Association. 2026 Sept 1;33(9):1811-1821. Epub 2026 Jun 11. doi: 10.1093/jamia/ocag080

The GUIDE-CDSS framework: a comprehensive framework to GUIDE and evaluate the implementation of Clinical Decision Support Systems in healthcare, based on an overview of reviews

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