In a quiet stretch of primary care, a decision-support tool sits waiting inside the electronic health record, ready to help with chronic pain, and yet clinicians reached for it in only a sliver of the visits studied. A PLOS Digital Health study, drawing on 145,511 encounters and 69 clinicians, reveals the gap between what a system can offer and what its users actually turn to in the middle of a working day. The finding reminds us that availability is not the same as adoption, and that tools must earn their place by meeting the real moments of clinical need and fitting the rhythms of existing w
Clinicians Opened EHR Decision-Support Tool in Just 0.7% of Chronic Pain Encounters
Available in the record does not mean used in the room
Mark
Why does a figure like 0.7 percent matter so much?
Mimi
Because it measures real behavior. The tool was there in 145,511 encounters across 69 clinicians, and it was opened in a tiny fraction of them.
Luke
Worth saying what it doesn't tell us. Low use isn't automatically a failure. We don't know from this reporting how often the tool would have been relevant.
Mark
Though the study did find it was used more in certain situations.
Mimi
Yes, when chronic pain was directly addressed or a patient was on long-term opioid therapy. That points to relevance driving use.
Luke
Pointing is the right word. The pattern is an association in the data, not proof of why clinicians chose to open it.
Mark
What about the finding that earlier use didn't predict later use?
Mimi
It suggests that trying the tool once didn't build a habit, at least in this data.
Luke
And the clinician-experience findings come with a flag: a few highly experienced participants may have shaped them. I'd hold those loosely.
Mark
So what's the takeaway?
Mimi
Availability alone may not be enough. Fit with workflow matters, and this kind of linked data lets organizations see it.
Il Polso
- Across 145,511 primary care encounters, the OneSheet chronic pain tool was opened in just 0.7 percent of visits, a striking silence inside a system built to speak up.
- Use rose only when chronic pain was directly in focus or long-term opioid therapy was being prescribed, leaving most routine visits untouched by the tool.
- Clinicians who had used OneSheet before were no more likely to return to it, so familiarity alone is failing to pull the tool into everyday practice.
- Researchers are pressing toward a clearer answer by matching clinical relevance and workflow fit, with the findings signaling that health systems must redesign access rather than simply switch it on.
In a quiet stretch of primary care, a decision-support tool sits waiting inside the electronic health record, ready to help with chronic pain, and yet clinicians reached for it in only a sliver of the visits studied. A PLOS Digital Health study, drawing on 145,511 encounters and 69 clinicians, reveals the gap between what a system can offer and what its users actually turn to in the middle of a working day. The finding reminds us that availability is not the same as adoption, and that tools must earn their place by meeting the real moments of clinical need and fitting the rhythms of existing work.
Across 145,511 primary care encounters involving 69 clinicians, a chronic pain decision-support tool built into the electronic health record was opened in only 0.7 percent of them. That is the core finding of a study published in PLOS Digital Health, which examined OneSheet, a tool meant to help primary care teams make evidence-based decisions, pull up relevant patient information, and work through complicated pain care. Its starting assumption is simple: placing a tool inside the health record does not guarantee anyone will use it in ordinary practice.
Answering who used OneSheet, and when, required more than access to records. The researchers had to join details of individual patient visits with data showing how clinicians interacted with the tool. The Research Data Services group brokered access to the linked information, including encounters, diagnoses, and prescriptions. Analyst Evgenia Teal worked alongside the research team and Eskenazi Health to shape the data needs, reviewing requirements step by step to make sure the clinical records were correctly connected to the usage data. The result allowed the team to observe the tool during real visits rather than relying on surveys or memory.
The patterns were clear. Clinicians were more likely to open OneSheet when chronic pain was the direct focus of a visit or when a patient was prescribed long-term opioid therapy. Having used the tool before did not make a clinician more likely to use it again. Differences also appeared based on clinician characteristics, though the researchers cautioned that some results about experience may reflect a small group of highly experienced participants.
The authors treat these findings as a caution. A decision-support tool sitting in the EHR may not be enough to encourage routine use. Understanding when a tool matters clinically, and how it fits into existing workflows, may guide health organizations toward better implementation. More broadly, as health systems introduce new digital technologies, evidence about actual use can help researchers, institutions, and developers identify barriers and judge whether a tool truly fits the work it is meant to support. Several other papers drawing on the same data are already extending this picture.
Across 145,511 primary care patient encounters, involving 69 clinicians, a chronic pain decision-support tool built into the electronic health record was opened in 0.7 percent of them. That is the central finding of a study published in PLOS Digital Health, which looked at a tool called OneSheet.
OneSheet is an EHR-based clinical decision-support tool designed to support chronic pain management in primary care. Tools of this kind are meant to help clinicians make evidence-based decisions, pull up relevant patient information and work through complicated care. But the study's starting point is a plain one: putting a tool inside the health record does not guarantee anyone will use it in routine practice.
Answering the question of who used OneSheet, and when, took more than access to health records. The researchers had to link two kinds of information: details about individual patient encounters, and data documenting how clinicians interacted with the tool. The Research Data Services group, referred to as RDS, brokered access to the EHR data tied to OneSheet use, including information on encounters, diagnoses and prescriptions.
Evgenia Teal, an RDS analyst, worked closely with the research team and with Eskenazi Health to identify the project's data needs. Through an iterative process, she and the team reviewed the requirements and worked to make sure the clinical information was appropriately linked to the usage data. The result was a base for studying the tool during actual patient encounters, rather than relying only on clinician surveys or recollections.
The analysis showed a few patterns. Clinicians were more likely to open OneSheet during encounters where chronic pain was directly addressed, or where a patient was prescribed long-term opioid therapy. Previous use did not make a clinician more likely to use the tool again. The researchers also saw differences in use based on clinician characteristics, though they noted that some findings about clinical experience may have been shaped by a small number of highly experienced participants.
The authors read the results as a caution: making a decision-support tool available in an EHR may not be enough to encourage routine use. Knowing when a tool is clinically relevant, and how it fits into existing workflows, may help health care organizations find ways to improve implementation.
The broader argument is about evidence. As health systems introduce new digital technologies, data on how tools are actually used can help researchers, health systems and developers identify barriers to adoption and assess how well a tool fits into workflow. RDS's work on this project also supported several other research papers examining OneSheet and its use in clinical care, so further findings from the same data are part of the picture.
Citazioni salienti
Making clinical decision-support tools available within an EHR may not be sufficient to encourage routine use.— Study findings as summarized by Medical Xpress
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