PCPs viewed diagnostic CDS for VTE as potentially beneficial but also potentially burdensome depending on how it is implemented within clinical workflows, with acceptance depending not only on technical performance but also on effects on workflow efficiency, clinician autonomy and perceived legal risk.
Key Findings
Results
Primary care providers described diagnosing VTE as challenging due to non-specific symptoms encountered in time-constrained clinical environments.
Eight PCPs, including physicians and physician assistants, were purposively sampled from two academic health systems in urban and rural regions of the USA.
Participants practised in primary or urgent care settings and completed semistructured interviews focused on diagnosing VTE and CDS use.
The qualitative method used was directed content analysis of semistructured interviews.
Non-specific symptom presentation and competing clinical demands were identified as core diagnostic challenges.
Results
Participants viewed a VTE-specific CDS as potentially valuable, particularly if integrated seamlessly into the electronic health record and capable of supporting risk stratification using existing clinical data.
PCPs expressed support for CDS tools that could leverage existing clinical data for risk stratification.
Seamless EHR integration was identified as a key feature for potential adoption.
The value of CDS was seen as contingent on how well it fit within existing clinical workflows.
Results
Clinicians identified substantial concerns regarding alert fatigue, workflow burden, limited specificity, and disruption of clinical autonomy as barriers to CDS adoption.
Alert fatigue was a prominent concern, with participants worried about CDS contributing to an already high burden of clinical notifications.
Limited specificity of CDS alerts was identified as a concern, suggesting risk of false positives driving unnecessary action.
Disruption of clinical autonomy was framed as a meaningful barrier, with providers preferring tools that support rather than direct clinical reasoning.
Workflow burden was cited as a factor that could undermine rather than enhance diagnostic efficiency.
Results
Medico-legal concerns emerged as a prominent theme, with participants expressing apprehension that ignoring CDS recommendations could increase liability risk, while following alerts could contribute to unnecessary diagnostic testing and downstream consequences.
Participants described a perceived tension between the legal risk of ignoring a CDS alert and the clinical risk of over-testing if the alert is followed.
This dual concern about liability was constructed as a prominent theme in the qualitative analysis.
Downstream consequences of unnecessary diagnostic testing (e.g., incidental findings, patient anxiety, costs) were cited as concerns.
The medico-legal framing suggests CDS adoption decisions are not purely clinical but also shaped by perceived professional and legal risk.
Results
Participants emphasised that CDS tools should be actionable, context-aware, minimally disruptive, and supportive of rather than directive to clinical reasoning.
Providers preferred CDS designed to augment rather than override clinical judgment.
Context-awareness — the ability of the tool to account for individual patient circumstances — was identified as a desirable feature.
Minimal disruption to workflow was cited as essential for acceptance.
Actionability, meaning the CDS should provide clear and usable guidance, was emphasized as a design priority.
Discussion
Acceptance of VTE diagnostic CDS in primary care appears to depend on technical performance, workflow efficiency, clinician autonomy, and perceived legal risk.
The study identified that no single factor drives CDS adoption; rather, multiple interacting dimensions shape provider acceptance.
Future CDS development was recommended to prioritise usability, workflow integration, and minimisation of unintended consequences such as alert fatigue and over-testing.
The findings were derived from a small purposive sample of eight PCPs, which limits generalisability but supports depth of qualitative insight.
The study spanned two academic health systems in both urban and rural US settings, providing some contextual diversity.
What This Means
This research explores how primary care providers (PCPs) — including doctors and physician assistants — think about using computer-based decision support tools to help diagnose venous thromboembolism (VTE), a condition that includes blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism). VTE is notoriously difficult to diagnose in primary care because its symptoms, such as leg swelling or shortness of breath, are vague and overlap with many other conditions. Researchers conducted in-depth interviews with eight PCPs across urban and rural US health systems to understand what would make such a tool helpful or problematic in real clinical settings.
The study found that providers were cautiously optimistic about VTE-specific decision support tools, especially if those tools could pull data already in the electronic health record and fit smoothly into existing workflows without adding extra steps. However, providers raised significant concerns: they worried about 'alert fatigue' — the phenomenon where too many pop-up notifications cause clinicians to start ignoring them — as well as about tools that are too generic or that undermine their professional judgment. A particularly notable finding was around legal concerns: providers felt caught between the fear of being blamed for ignoring a computer alert if something went wrong, and the fear of ordering unnecessary tests (with their own risks and costs) simply because the tool suggested it.
This research suggests that the success of clinical decision support for VTE diagnosis in primary care is not just a matter of how accurate the technology is — it also depends heavily on how the tool is designed to fit into busy clinical environments, respect provider expertise, and avoid creating new problems like over-testing or workflow disruption. The findings point to the importance of involving frontline clinicians early in the design process and building tools that feel like helpful assistants rather than additional sources of obligation or liability.
Baris V, Frost A, Sainlaire M, Chen J, Shukla M, Apurba M, et al.. (2026). Exploring primary care providers' perspectives on clinical decision support for venous thromboembolism diagnosis: a qualitative study.. BMJ open. https://doi.org/10.1136/bmjopen-2026-122559