Organizational factors affecting implementation of the ATHENA-Hypertension clinical decision support system during the VA’s nation-wide information technology restructuring: a case study

This case study documents organizational factors that affected implementation of the ATHENA‐Hypertension (ATHENA‐HTN) clinical decision support system (CDSS) at five medical centers within the U.S. Department of Veterans Affairs (VA). The ATHENA‐HTN implementation occurred during a system‐wide reorganization of the VA’s Office of Information & Technology (OI&T) to a centralized information technology (IT) system with heightened security. Guided by a logic‐model framework, we used template analysis and grounded methods to identify barriers and enablers to the ATHENA‐HTN implementation process. Implementation barriers included limited autonomy within a centralized reporting structure, permissions issues for remote computer access, and uncertainty regarding standardized procedures. Strategies to overcome these barriers included garnering support from clinical and IT leadership, validating data with physicians at local medical centers, and establishing IT communication channels. The findings from this study provide insights for the implementation of CDSS within integrated healthcare networks, particularly during periods of IT restructuring and organizational change.