duties of a system administrator vary from organization to organization. System administrators are supposed to install, support, and maintain servers and other computer systems. They are also expected to respond to service outages and other problems.

2.1.5. System Maintenance Team

The maintainer is concerned with 1) a comprehensible, consistent, and documented design, 2) the ease with which modifications can be made, 3) how the knowledge underlying the rule will be maintained and updated, 4) how the rule will be encoded or interfaced with the application that will use it, 5) how it relates to other rules, 6) how it can be deployed in other applications or other system platforms with different programming languages, architectures, and developer’s convention, and 7) how knowledge and CDS approaches, which are found to be effective can be broadly disseminated and used.

2.1.6. Sales and Marketing Team

The CDSS marketing team is mainly concerned with product, price, promotion, and place along with affecting environmental factors, including social, cultural, economic, technology, competition, ecological, political and legal. Though the decision support system has been implemented across various application areas, however, a successful decision support system implementation is still nascent. CDSS market is still emerging and undergoing through the trial phase. The failed deployment in the past has deterred the adoption of the CDSS [22] . Clinical decision support has become an integral part of healthcare delivery. Healthcare stakeholders need to monitor this sector closely if they wish to gain competitive advantage.

Marketing personnel have to understand the CDSS products, its need, features and their position with other products if they want to penetrate the market. For example, they need to understand what kind of CDSS products are being used by doctors, shortcomings of the existing product, and so. They, somehow, need to prove that a new upcoming product is superior to the existing products. Customers, especially medical professionals, are very reluctant to change due to highly busy life. Moreover, newly software products need a considerable time to learn. Whenever a new CDSS product comes to the market without significant changes in features, as well as prices, very few chances exist that customers will accept the new CDSS product. Therefore, marketing personnel have to decide the competitive price and approach to pricing, for example; some firms believe in a subscription model, while others have chosen a one-time pricing strategy that covers the buyer for a fixed period [23] [24] . At times, it happens that CDSS with useful features at a reasonable cost may not get accepted by the users as they are so used to existing product, even though existing product might have fewer features and higher the new arrival in the product line. In such case, various promotion strategies like coupons, sample, partnerships, and sponsors are adopted by CDSS marketers. The CDSS product needs to be customized as per the place. CDSS developed in Europe will have different features than the USA. Marketing guys also decide the mode of delivery. The preferred mode is to upload to server and client download from its site using the Internet.

2.1.7. End-User

Physician, nurse, laboratory technologist, pharmacist, and patient are the primary users of the CDSS. All of them have their expectation with CDSS-some met and some unmet. CDSS should behave as per user expectation. Users want a product that does what they need to be done [25] . One out of five ICT (Information and Communication Technology) projects is likely to bring satisfaction, which is very true in the case of CDSS [26] . In July 2007, the head of the National Health Service Department in Britain stated that he was ashamed of some of the ICT systems developed during his period. The developed systems were unusable because they were built without listening to what end-users want. The computer science domain lacks the methods and tools to represent the complexity of user tasks, the contexts and sets of information and knowledge that must be harvested for context relevant information push and pull in health care. Further, health ICT system vendors lack the skills, tools, and probably the financial resources to create truly useful systems for clinicians. As physicians are awfully busy people in this world, they cannot give much time to learn things that seem to be out of the track from their routine work. Therefore, CDSS should have an appeal to understand or know it immediately without needing much thinking and learning.

Usability is important component demanded by the end-users. Medical computer systems that take usability into consideration allow users to improve clinical productivity effectively and efficiently while promoting positive feelings of satisfaction. CDSS shares similar usability issues as other applications and raises unique user concerns [27] . In other words, very simple and intuitive user interface is very much desirable. The history of CDSS reveals that the poor interface design is one of the leading causes of the failure or low adoption of CDSS. In the CDSS, the outcome of the system is directly related to the user interface. A successful CDSS should offer a user-friendly interface to clinicians to get the most proper consultation results [28] .

The performance of CDSS is non-functional expectation of the end-users. For example, if a CDSS takes a longer time than the users’ willing to wait, the system is considered as failed to perform even though it eventually gives a support. Similarly, other non-functional expectation from the CDSS is reliability. The reliability of a system is commonly defined as the ratio of the amount of time the system is truly available (during the time it is expected to be available) to the amount of time; the system is supposed to be available. Less than 99% reliable are typically considered as bad. For example, suppose a system is functional for a year with 99% reliability, it was down, on average over eighty-seven hours annually [26] . This system would be considered as non-reliable. Over the past few years, we can see increased awareness of the data privacy and security in the healthcare sector. Healthcare decision support systems comprise of large volumes of sensitive data; therefore, a high degree of data protection should be ensured. Protection of highly confidential patient data is subject to international regulations. Issues of privacy, software regulation and ethical and legal aspects of data processing in healthcare may build primary sources of conflicts [29] .

3. Conclusion

CDSS has been accepted as a revolutionary idea in the field of medicine. However, to date, their success is not encouraging despite pumping in a huge effort, as well as money. Several challenges along with potential reasons have been identified. We found that CDSS involved diverse competing stakeholders. And CDSS challenges have risen because these various stakeholders have different interests and asymmetric information―some having more interest or information than others. Moreover, their interests are not aligned with a common goal. Therefore, before embarking on any CDSS development, stakeholders need to be considered seriously, and interests of various stakeholders can be brought into line with CDSS objectives.

Cite this paper
Kumar, A. (2016) Stakeholder’s Perspective of Clinical Decision Support System. Open Journal of Business and Management, 4, 45-50. doi: 10.4236/ojbm.2016.41005.
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