Table 3.

Inductively identified categories and corresponding barriers and facilitator

Categories *	Barriers	Facilitators
Mobile workflow (2 – 0)	- PE Dx cannot be used on a phone and is not mobile therefore, it cannot be used while walking between patient rooms or on the phone in a patient room while discussing the patient’s risk
Computer access (2 – 2)	- The computers in the patient rooms are slow making it harder to use PE Dx while talking with patients	- PE Dx is easy to use because the physician has easy access to computers in the ED - PE Dx can be used on computers in the patient room in The American Center (TAC)
Resident workflow in other services (3 – 0)	- Resident physicians rotate out of the ED into other services where they learn new workflows. PE Dx does not fit in this new workflow when the resident returns to the ED (e.g., residents spend a lot of time in the notes and use MDCalc when in other services)
Preference for another CDS (5 – 0)	- MDCalc is easier to use than the PE Dx because physicians usually have an internet browser open on their computer during the shift
Integration of multiple CDS (7 – 1)	- There are no other CDS in the EHR like PE Dx, which makes it less appealing to use - MDCalc has multiple different risk scores making it a “one-stop shop” for calculating the patient’s risk for different possible conditions	- As more CDS like PE Dx are in the EHR, PE Dx will better fit in physician workflow; the physician can then go to one spot in the EHR to calculate all applicable risk scores
Time pressure (3 – 0)	- Time pressure in the ED makes it less likely that a physician will use PE Dx - Physicians may revert to gestalt or use MDCalc on their phone instead of PE Dx
Integration within EHR (4 – 2)	- Using PE Dx interrupts the workflow because the physician needs to leave their current task in the EHR to access and use PE Dx - The ED navigator where PE Dx is located in the EHR is cluttered making it hard to find the CDS	- PE Dx is a good adjunct for the EHR and works well because it is embedded in the EHR
Physician-patient workflows (3 – 3)	- PE Dx is difficult to use if the physician forgets to ask patients one of the criteria questions; in this case, the physician needs to return to the patient room before completing PE Dx	- PE Dx can be used while placing orders in the patient room - PE Dx best fits the workflow after the physician sees the patient and before placing orders - As the physician continues to use PE Dx, it will become part of the workflow to ask patients the criteria questions
Availability of residents (1 – 2)	- The attending is less likely to use PE Dx at UW because the residents are there	- PE Dx is more useful when the attending is at TAC without residents
Interruptions (0 – 1)		- PE Dx is short, so interruptions do not affect use of the tool
Preference for another PE workflow (3 – 0)	- The physician does not use PE Dx because they already have a PE workflow - The physician tried PE Dx and then reverted to their old workflow - Physician prefers to use the Geneva score versus the Wells’
Attending-resident tasks (2 – 0)	- Attendings are not the main users of PE Dx as residents place the orders for patients - PE Dx does not fit with the other tasks attendings are doing when deciding what to do for PE, such as listening to residents about the patient presentation and reviewing the chart and current orders
Gestalt and memorization of criteria (9 – 0)	- Physician does not need PE Dx because they have the risk criteria memorized - Physician gestalt is good enough to determine appropriate diagnostic pathway (e.g., if the physician gestalt is that Wells’ is low, the physician may only want to use PERC)
Teaching tool (0 – 10)		- PE Dx is useful as a teaching tool for medical students, residents, and advanced practice providers (APPs)
Adaptation for patient risk (6 – 2)	- Use of PE Dx varies depending on the patient scenario such as patient age (e.g., over 50 years old) and risk level (e.g., young, cancer patient, pregnant). For example, the PERC criteria are not relevant if the patient is over 50 - If the patient is high risk, the physician goes straight to ordering a CT scan	- PE Dx is helpful for moderate and high-risk patients as it helps justify the diagnostic pathway and order chosen - PE Dx is helpful when a physician thinks a patient is low risk, but is uncertain on the true risk
Ordering workflow (4 – 3)	- The physician prefers to place all orders at the same time instead of only placing the order for PE diagnosis. The CDS does not fit this workflow of placing all orders at once - Physicians use a workaround of placing all orders and then using PE Dx to confirm their decision or using PE Dx and then placing all of the orders together afterwards - If the physician places the D-dimer order separately from the other orders, it may interfere with the nursing workflow of drawing blood - The physician is less likely to use PE Dx if they have already placed other orders while in the patient room	- PE Dx can be used while placing orders in the patient room - It is easy to place the PE Dx order separate from the other orders - PE Dx fits in the ordering workflow, in which a physician returns to the computer station after talking with a patient
Access to CDS evidence (2 – 0)	- MDCalc is better than PE Dx because it provides literature that supports the recommendation and rationale for the criteria
Alerts (10 – 3)	- Because there is no alert, the physician sometimes forgets to use PE Dx - The physician did not know PE Dx existed - It would be hard to find the best time in the workflow for an alert - PE Dx would better integrate in the workflow if there was an alert or a reminder to use it	- PE Dx is better than other CDS because there is no alert or pop-up to use it, which would interrupt the workflow

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