From Concept to Reality: Examining India’s Clinical Decision Support System (CDSS) Challenges & Opportunities

Background Clinical Decision Support Systems (CDSS) are rapidly altering the face of healthcare and their potential to improve patient outcomes has been exploited, in some countries. This study aims to explore the current landscape of the Indian healthcare sector to identify the favourability of current practises, organisational and infrastructural readiness, attitudes and concerns of the stakeholders concerning the implementation of CDSS. Methods The methodology that this study used was carrying out structured interviews comprising of 16 close-ended questions, split into three sub-categories. There was a total of 61 interviews were conducted with medical and administrative staff in public and privately run facilities, present in Tier 1 and Tier 2 cities in India. The study will focus on hospitals in Tier 1 cities as these are in a position to bring technological transformation. Results The results identified various trends and patterns that would likely govern the incorporation of CDSS. A large proportion of the experts answered positively about the current level of digitalisation of their workplace and the availability of funds for future innovation, indicating high favourability for CDSS. Various roadblocks were isolated with respect to stakeholder attitudes, standardisation of care and general knowledge about CDSS and that in two cities, privately owned facilities were better equipped than state-run facilities. Conclusions There have been many recent initiatives in India to promote digital health. Performing a CDSS cost-effectiveness study will demonstrate the benefits of using CDSS in the country to overcome any adoption hesitancies. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: At the outset, the research methodology was approved by YouDiagnose Ethical Approval Committee. This research work was commenced after this approval and this study did not involve any human data, tissues, samples or materials. Consent to participate was obtained from each participant at the beginning of the study. Using the NHS Health Research Authority and United Kingdom Medical Research Council decision-making tool, it was determined that this study would produce generalisable or transferable findings. Therefore, informed consent was obtained from each participant before the structured interview. It was also determined that the study would anonymize the participants to mitigate any risk. All the methodologies were in line with the core practices of the Committee on Publication Ethics (COPE) and the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript * AI : Artificial Intelligence BIS : Bank for International Settlements CDSS : Clinical Decision Support Systems CT : Computed Tomography DISHA : Information Security in Healthcare Act ECG : Electrocardiogram EHR : Electronic Health Record GDP : Gross Domestic Product Health IT : Health Information Technology ID : Identity IHIP : Integrated Health Information Program MDR-TB : Multidrug-Resistant Tuberculosis NeHA : National e-Health Authority OECD : Organisation for Economic Co-operation and Development WHO : World Health Organization SOP : Standard Operating Procedure MDT : Multi Disciplinary Team