{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:07:43Z","timestamp":1779916063396,"version":"3.53.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100000923","name":"Australian Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000923","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-025-02141-9","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T04:47:26Z","timestamp":1764996446000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mixed methods evaluation of a clinical decision support system to reduce variation in healthcare"],"prefix":"10.1038","volume":"8","author":[{"given":"Anton","family":"Pak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha T.","family":"Robertson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao Hoang","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hodgson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clair","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Burton-Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"2141_CR1","doi-asserted-by":"publisher","first-page":"e13313","DOI":"10.2196\/13313","volume":"21","author":"TK Colicchio","year":"2019","unstructured":"Colicchio, T. K., Cimino, J. J. & Del Fiol, G. Unintended consequences of nationwide electronic health record adoption: challenges and opportunities in the post-meaningful use era. J. Med. Internet Res. 21, e13313 (2019).","journal-title":"J. Med. Internet Res."},{"key":"2141_CR2","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1287\/isre.2018.0813","volume":"30","author":"Y-K Lin","year":"2019","unstructured":"Lin, Y.-K., Lin, M. & Chen, H. Do electronic health records affect quality of care? Evidence from the HITECH Act. Inf. Syst. Res. 30, 306\u2013318 (2019).","journal-title":"Inf. Syst. Res."},{"key":"2141_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jom.2018.06.003","volume":"60","author":"D Wani","year":"2018","unstructured":"Wani, D. & Malhotra, M. Does the meaningful use of electronic health records improve patient outcomes?. J. Oper. Manag. 60, 1\u201318 (2018).","journal-title":"J. Oper. Manag."},{"key":"2141_CR4","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1377\/hlthaff.2010.0274","volume":"29","author":"DJ Brailer","year":"2010","unstructured":"Brailer, D. J. Guiding the health information technology agenda. Health Aff. 29, 586\u2013595 (2010).","journal-title":"Health Aff."},{"key":"2141_CR5","doi-asserted-by":"publisher","first-page":"e30432","DOI":"10.2196\/30432","volume":"9","author":"T Hodgson","year":"2021","unstructured":"Hodgson, T., Burton-Jones, A., Donovan, R. & Sullivan, C. The role of electronic medical records in reducing unwarranted clinical variation in acute health care: systematic review. JMIR Med. Inform. 9, e30432 (2021).","journal-title":"JMIR Med. Inform."},{"key":"2141_CR6","doi-asserted-by":"crossref","unstructured":"Hodgson, T., Burton-Jones, A. & Sullivan, C. Addressing unwarranted clinical variation in healthcare as a quality improvement process. In Proc. 55th Hawaii International Conference on System Sciences 3885\u20133891 (IEEE, 2022).","DOI":"10.24251\/HICSS.2022.474"},{"key":"2141_CR7","doi-asserted-by":"publisher","first-page":"e54022","DOI":"10.2196\/54022","volume":"8","author":"S Naicker","year":"2024","unstructured":"Naicker, S. et al. Patterns and perceptions of standard order set use among physicians working within a multihospital system: mixed methods study. JMIR Form. Res. 8, e54022 (2024).","journal-title":"JMIR Form. Res."},{"key":"2141_CR8","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1111\/jep.13181","volume":"26","author":"K Sutherland","year":"2020","unstructured":"Sutherland, K. & Levesque, J. F. Unwarranted clinical variation in health care: definitions and proposal of an analytic framework. J. Eval. Clin. Pract. 26, 687\u2013696 (2020).","journal-title":"J. Eval. Clin. Pract."},{"key":"2141_CR9","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.25300\/MISQ\/2017\/41.4.04","volume":"41","author":"S Ayabakan","year":"2017","unstructured":"Ayabakan, S., Bardhan, I., Zheng, Z. & Kirksey, K. The impact of health information sharing on duplicate testing. MIS Q. 41, 1083\u20131104 (2017).","journal-title":"MIS Q."},{"key":"2141_CR10","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/jep.12930","volume":"25","author":"R Harrison","year":"2019","unstructured":"Harrison, R. et al. Addressing unwarranted clinical variation: a rapid review of current evidence. J. Eval. Clin. Pract. 25, 53\u201365 (2019).","journal-title":"J. Eval. Clin. Pract."},{"key":"2141_CR11","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1136\/bmj.325.7370.961","volume":"325","author":"JE Wennberg","year":"2002","unstructured":"Wennberg, J. E. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ 325, 961\u2013964 (2002).","journal-title":"BMJ"},{"key":"2141_CR12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1136\/archdischild-2017-312740","volume":"103","author":"J Runnacles","year":"2018","unstructured":"Runnacles, J., Rouech\u00e9, A. & Lachman, P. The right care, every time: improving adherence to evidence-based guidelines. Arch. Dis. Child. Educ. Pract. 103, 27\u201333 (2018).","journal-title":"Arch. Dis. Child. Educ. Pract."},{"key":"2141_CR13","doi-asserted-by":"publisher","first-page":"113816","DOI":"10.1016\/j.dss.2022.113816","volume":"159","author":"Y Park","year":"2022","unstructured":"Park, Y., Bang, Y. & Kwon, J. Clinical decision support system and hospital readmission reduction: evidence from US panel data. Decis. Support Syst. 159, 113816 (2022).","journal-title":"Decis. Support Syst."},{"key":"2141_CR14","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1071\/AH17255","volume":"42","author":"R Eden","year":"2018","unstructured":"Eden, R., Burton-Jones, A., Scott, I., Staib, A. & Sullivan, C. Effects of eHealth on hospital practice: synthesis of the current literature. Aust. Health Rev. 42, 568\u2013578 (2018).","journal-title":"Aust. Health Rev."},{"key":"2141_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1748-5908-6-91","volume":"6","author":"N Sahota","year":"2011","unstructured":"Sahota, N. et al. Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implement. Sci. 6, 1\u201314 (2011).","journal-title":"Implement. Sci."},{"key":"2141_CR16","doi-asserted-by":"crossref","unstructured":"Eden, R. et al. Unpacking the complexity of consistency: insights from a grounded theory study of the effective use of electronic medical records. In Proc. 51st Hawaii International Conference on System Sciences (IEEE, 2018).","DOI":"10.24251\/HICSS.2018.381"},{"key":"2141_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13012-017-0644-2","volume":"12","author":"EG Liberati","year":"2017","unstructured":"Liberati, E. G. et al. What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation. Implement. Sci. 12, 1\u201313 (2017).","journal-title":"Implement. Sci."},{"key":"2141_CR18","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-020-0221-y","volume":"3","author":"RT Sutton","year":"2020","unstructured":"Sutton, R. T. et al. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit. Med. 3, 17 (2020).","journal-title":"NPJ Digit. Med."},{"key":"2141_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11892-017-0883-2","volume":"17","author":"JB Echouffo-Tcheugui","year":"2017","unstructured":"Echouffo-Tcheugui, J. B. & Garg, R. Management of hyperglycemia and diabetes in the emergency department. Curr. Diab. Rep. 17, 1\u20138 (2017).","journal-title":"Curr. Diab. Rep."},{"key":"2141_CR20","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/j.diabres.2011.09.012","volume":"94","author":"EA Nyenwe","year":"2011","unstructured":"Nyenwe, E. A. & Kitabchi, A. E. Evidence-based management of hyperglycemic emergencies in diabetes mellitus. Diab. Res. Clin. Pract. 94, 340\u2013351 (2011).","journal-title":"Diab. Res. Clin. Pract."},{"key":"2141_CR21","doi-asserted-by":"publisher","first-page":"104596","DOI":"10.1016\/j.ijmedinf.2021.104596","volume":"157","author":"B Sly","year":"2022","unstructured":"Sly, B., Russell, A. W. & Sullivan, C. Digital interventions to improve safety and quality of inpatient diabetes management: a systematic review. Int. J. Med. Inform. 157, 104596 (2022).","journal-title":"Int. J. Med. Inform."},{"key":"2141_CR22","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.2337\/dc21-0829","volume":"45","author":"AR Pichardo-Lowden","year":"2022","unstructured":"Pichardo-Lowden, A. R. et al. Clinical decision support for glycemic management reduces hospital length of stay. Diab. Care 45, 2526\u20132534 (2022).","journal-title":"Diab. Care"},{"key":"2141_CR23","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/TME.0000000000000178","volume":"40","author":"AMJ Blair","year":"2018","unstructured":"Blair, A. M. J., Hamilton, B. K. & Spurlock, A. Evaluating an order set for improvement of quality outcomes in diabetic ketoacidosis. Adv. Emerg. Nurs. J. 40, 59\u201372 (2018).","journal-title":"Adv. Emerg. Nurs. J."},{"key":"2141_CR24","first-page":"297","volume":"43","author":"K Flood","year":"2019","unstructured":"Flood, K. et al. Implementation and evaluation of a diabetic ketoacidosis order set in pediatric type 1 diabetes at a tertiary care hospital: a quality-improvement initiative. Can. J. Diab. 43, 297\u2013303 (2019).","journal-title":"Can. J. Diab."},{"key":"2141_CR25","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1002\/(SICI)1096-9136(199706)14:6<482::AID-DIA371>3.0.CO;2-A","volume":"14","author":"R Singh","year":"1997","unstructured":"Singh, R., Perros, P. & Frier, B. Hospital management of diabetic ketoacidosis: are clinical guidelines implemented effectively?. Diabet. Med. 14, 482\u2013486 (1997).","journal-title":"Diabet. Med."},{"key":"2141_CR26","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s00592-006-0227-1","volume":"43","author":"E Sola","year":"2006","unstructured":"Sola, E. et al. Management of diabetic ketoacidosis in a teaching hospital. Acta Diabetol. 43, 127\u2013130 (2006).","journal-title":"Acta Diabetol."},{"key":"2141_CR27","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1038\/nrendo.2016.15","volume":"12","author":"G Umpierrez","year":"2016","unstructured":"Umpierrez, G. & Korytkowski, M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat. Rev. Endocrinol. 12, 222\u2013232 (2016).","journal-title":"Nat. Rev. Endocrinol."},{"key":"2141_CR28","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1093\/jamia\/ocw145","volume":"24","author":"M Prgomet","year":"2017","unstructured":"Prgomet, M., Li, L., Niazkhani, Z., Georgiou, A. & Westbrook, J. I. Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis. J. Am. Med. Inform. Assoc. 24, 413\u2013422 (2017).","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"2141_CR29","first-page":"36","volume":"3","author":"S Devaraj","year":"2014","unstructured":"Devaraj, S., Sharma, S. K., Fausto, D. J., Viernes, S. & Kharrazi, H. Barriers and facilitators to clinical decision support systems adoption: a systematic review. J. Bus. Adm. Res. 3, 36 (2014).","journal-title":"J. Bus. Adm. Res."},{"key":"2141_CR30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2021.104506","volume":"152","author":"L Westerbeek","year":"2021","unstructured":"Westerbeek, L. et al. Barriers and facilitators influencing medication-related CDSS acceptance according to clinicians: a systematic review. Int. J. Med. Inform. 152, 104506 (2021).","journal-title":"Int. J. Med. Inform."},{"key":"2141_CR31","unstructured":"StataCorp. Stata Statistical Software: Release 18 (StataCorp LLC, College Station, TX, 2023)."},{"key":"2141_CR32","doi-asserted-by":"crossref","unstructured":"Braun, V., Clarke, V., Hayfield, N. & Terry, G. Thematic analysis. In Handbook of Research Methods in Health Social Sciences (ed. Liamputtong, P.) 843\u2013860 (Springer Nature, 2019).","DOI":"10.1007\/978-981-10-5251-4_103"},{"key":"2141_CR33","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s11135-021-01182-y","volume":"56","author":"D Byrne","year":"2022","unstructured":"Byrne, D. A worked example of Braun and Clarke\u2019s approach to reflexive thematic analysis. Qual. Quant. 56, 1391\u20131412 (2022).","journal-title":"Qual. Quant."},{"key":"2141_CR34","unstructured":"NVivo (Lumivero, 2023)."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-02141-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-02141-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-02141-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:00:27Z","timestamp":1766577627000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-02141-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2141"],"URL":"https:\/\/doi.org\/10.1038\/s41746-025-02141-9","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]},"assertion":[{"value":"25 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"781"}}