Provider Perspectives on Sociotechnical Alignment of Intelligent Clinical Decision Support Systems

Intelligent Clinical Decision Support Systems (ICDSS) are increasingly integrated into healthcare settings to enhance clinical decision-making, efficiency, and patient safety. Despite advances in artificial intelligence-enabled decision support, ICDSS adoption remains inconsistent, particularly in complex clinical environments where professional autonomy, workflow alignment, and accountability are critical. This study examines healthcare providers’ perspectives on ICDSS through a grounded theory approach informed by established Information Systems theories, including the Unified Theory of Acceptance and Use of Technology (UTAUT), Technology Acceptance Model (TAM), Diffusion of Innovation (DOI), and the Human-Organization-Technology fit (HOT-fit) framework. Semi-structured interviews were conducted with 11 providers within a large, integrated healthcare organization, and data were analyzed using open, axial, and selective coding. The findings reveal three interrelated dimensions shaping ICDSS use: provider experience, clinical utility, and adaptation. While ICDSS were perceived as valuable for improving efficiency, supporting treatment decisions, and enhancing patient safety, their adoption was constrained by cognitive overload, workflow misalignment, data quality concerns, and perceived threats to professional autonomy. Trust, explainability, and workflow fit emerged as central mechanisms influencing selective use rather than full adoption. By grounding provider perspectives within a sociotechnical lens, this study extends existing IS theories to the context of AI-enabled clinical decision support and offers empirically grounded insights for designing ICDSS that better align with clinical practice.