Background <p>Clinical decision support systems (CDSS) for renal anemia among hemodialysis patients are gaining clinical attention. However, wide adoption remains challenging, and critical factors concerning physician acceptance remain elusive. This qualitative study conducted in-depth interviews with nephrologists to determine the relevant factors influencing physician acceptance.</p> Methods <p>Seventeen nephrologists in the hemodialysis center at Far Eastern Memorial Hospital participated in semi-structured, in-depth interviews to explore their views and concerns regarding CDSS. The qualitative study was performed under the well-established framework of the unified theory of acceptance and use of technology (UTAUT).</p> Results <p>The majority of participating physicians (14 of the 17) believed that a CDSS could streamline their workflow and save time. All participants agreed that robust clinical evidence of CDSS efficacy was critical to enhance CDSS acceptance. In addition, physicians noted that CDSS provides educational value, promotes patient safety and quality of care, and aligns with future technological trends. Despite these benefits, physicians raised concerns regarding dependence, distrust, and potential interference, which related to the physician professionalism. The UTAUT model should be extended with additional construct of autonomy in recognition of physician professionalism.</p> Conclusion <p>This qualitative study revealed that nephrologists expressed positive views on the CDSS for anemia management. They acknowledged that the CDSS could enhance their work efficiency, improve patient safety, enhance care quality, and provide educational value. To optimize the acceptance of the CDSS under the UTAUT-Autonomy framework, the design and implementation of the CDSS should also address three additional key factors: over-dependence, distrust, and workflow interruption.</p>