Table 2.

Description of barriers and facilitators related to the HF design principles

HF principles	Barriers	Facilitators
Automation of information acquisition (3 – 9)	- PE Dx may auto-populate incorrect data (e.g., incorrect vitals in the chart) - PE Dx does not pull in enough data	- Automatically populates data (e.g., vital signs, age)
Automation of information analysis (2 – 7)	- Physician does not need the exact Wells’ score	- PE Dx helps determine if the present risk factors (e.g., prior DVT) put the patient in the D-dimer or CT scan threshold - Exact Wells’ score and recommendation helps physician remember the cut-offs for risk
Support of decision selection (4 – 24)	- There is a pop-up alert when the PE Dx recommends a D-dimer but the physician does not have high enough suspicion to place the order	- PE Dx gives a clear recommendation based on patient risk
Explicit control/flexibility (5 – 1)	- PE Dx may force the physician down a PE pathway; it is hard to not order a diagnostic test after a high score is recorded in the chart - The physician cannot edit PE Dx documentation throughout patients’ ED visit	- PE Dx is a resource but is not mandatory
Minimization of workload (29 – 53)	- PE Dx is slower than other risk calculators (e.g., MDCalc) - PE Dx documentation support does not work if the physician has already started their note - The physician has to click “refresh” to get PE Dx documentation in the note - It is easier for physicians to use dictation than to use documentation support in PE Dx - PE Dx is hard to access in the EHR due to its location - PE Dx is slower than using gestalt; PE Dx is extra clicks for things the physician is already thinking about	- PE Dx supports ordering the recommended test, which saves clicks - PE Dx does not require a lot of scrolling or clicking - PE Dx reduces the need to go searching in the chart for information - PE Dx is embedded in the EHR, so physicians do not need to go to another website to calculate the risk scores - PE Dx does not require the physician to use the PERC if the Wells’ is high enough to go straight to ordering a test
Consistency (1 – 6)	- Do not like the color scheme of PE Dx, which is the color scheme of Epic	- PE Dx is similar to other online risk scores for PE (e.g., MDCalc); the criteria are listed in the same order and the yes/no boxes are the same
Chunking/grouping (27 – 10)	- Physician considers Wells’ and PERC at one time, not as separate criteria - Physician often starts with PERC rather than Wells’ - Location of PE Dx in the EHR (ED navigator) does not fit in physician workflow	- PE Dx is easily accessible; the ED navigator is a common place physicians are working - PE Dx sequence of using Wells’ before PERC reminds the physician of the intention for the risk scores
Visibility (2 – 6)	- Physicians did not understand all of the functionalities of the PE Dx (e.g., physician did not know how to edit the documentation or vital signs)	- Point values are listed on the yes/no buttons - PE Dx provides interpretation of patient risk scores - Exact patient scores get documented in the chart
Error prevention (1 – 9)	- Physician does not always use Wells’ before PERC; PE Dx forces this workflow to prevent errors	- PE Dx reminds physicians of the risk information and questions to ask patients (e.g., hemoptysis) - Cannot access PERC without low Wells’ score

^*The numbers in parentheses represent the total number of excerpts coded as barriers and facilitators