Cross-Site Transfer and Adaptation of an In-House CDSS: First Lessons Learned.

INTRODUCTION: This study investigates the transfer of core components of an in-house clinical decision support system (CDSS) between two university hospitals in Germany, aiming to derive transferable lessons for CDSS transfer. STATE OF THE ART: While frameworks for CDSS implementation are well established, guidance on transferring in-house systems to independent clinical sites remains limited, particularly from the perspective of the adopting institution. CONCEPT: The study frames transfer as a structured process of recontextualization, differentiating site-agnostic core components from locally adapted elements and applying the NASSS framework to systematically identify transferable challenges and scalable strategies. IMPLEMENTATION: Core components were conceptually integrated with local infrastructure via a modular design, including a data ingestion layer and a UI integration layer, enabling site-specific adaptation and seamless EHR embedding. The system is intended to support clinicians managing patients at risk of acute kidney injury. LESSONS LEARNED: Key lessons highlight the importance of modular, adaptable components, transparent data pipelines, tailored user interfaces, early stakeholder engagement, robust regulatory and quality management capacity, and consideration of broader system requirements within the applicable regulatory context.