What is it about?
Clinical decision support (CDS) tools are designed to help healthcare providers make informed, evidence-based decisions, but many of these tools are rarely used in practice. We studied the use of a chronic pain management CDS tool called OneSheet by primary care clinicians across more than 145,000 patient encounters. We found that clinicians used the tool in less than 1% of eligible encounters overall. However, they were much more likely to use it when caring for patients with chronic pain diagnoses or patients receiving long-term opioid therapy, situations where quick access to relevant information may be particularly valuable. We also found that clinician characteristics mattered. Female clinicians and clinicians with more years of experience were more likely to use the tool in these clinically relevant situations. Our findings suggest that simply making a digital tool available is not enough. To improve adoption, CDS tools should fit naturally into clinical workflows and be designed with the needs of different types of users in mind.
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Why is it important?
Healthcare organizations continue to invest heavily in clinical decision support technologies to improve quality, safety, and adherence to evidence-based care. Yet adoption remains a major challenge. This study goes beyond asking whether clinicians use a CDS tool by examining which clinicians use it and under what circumstances. Using real-world electronic health record data rather than self-reported surveys, we show that CDS use is strongly influenced by both patient context and clinician characteristics. These findings highlight the importance of designing and implementing digital health tools that are clinically relevant, fit existing workflows, and account for differences in clinician experience and practice patterns. As healthcare systems increasingly rely on digital tools to support complex care, understanding the factors that drive real-world adoption is critical to realizing their intended benefits.
Perspectives
This publication is particularly meaningful to me because it moves beyond the question of whether clinical decision support works and focuses instead on a challenge that often receives less attention: whether clinicians actually use these tools in practice. By analyzing real-world electronic health record data, we were able to study CDS use as it occurs in everyday clinical care rather than relying on surveys or self-reported behavior. I was especially interested in understanding how clinician characteristics influence technology use because healthcare technologies are often implemented as though all users will engage with them in the same way. I hope this work encourages researchers, developers, and health systems to think more carefully about designing and implementing digital health tools that work for diverse users and fit the realities of clinical practice.
Emma McCord
University of Arkansas for Medical Sciences
Read the Original
This page is a summary of: Factors associated with chronic pain clinical decision support use in primary care, PLOS Digital Health, July 2026, PLOS,
DOI: 10.1371/journal.pdig.0001032.
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