Barriers to the Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Qualitative Interview Study

  • Authors
  • Douglas Barnaby
  • Katherine L. Dauber-Decker
  • Renee Pekmezaris
  • Safiya Richardson
  • Thomas McGinn
  • Adithya Cattamanchi
  • Published
  • JMIR Human Factors



Clinicians often disregard potentially beneficial clinical decision support (CDS).


In this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool.


We conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells’ criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging.


Interviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells’ criteria, (5) missed risk factors, and (6) social pressure.


Clinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care.

  • Keywords
  • Clinical Decision Support Systems
  • Electronic Health Record
  • Pulmonary embolism
  • Quality improvement
  • Medical Informatics