Across a stream of nearly a hundred and fifty thousand primary care visits, a tool meant to steady the hand of clinicians facing chronic pain was reached for in fewer than one visit in a hundred. The finding, set down in PLOS Digital Health in July 2026, reminds us that a helpful instrument does not help simply by existing; it must meet the particular person, the particular patient and the particular moment. The quiet patterns beneath the number, shaped by who the patient is and who the clinician has become, suggest that adoption is less a matter of distribution than of fit.
Clinicians Used Chronic Pain Decision Support in Under 1% of Visits, With Gaps Tied to Gender and Experience
The tool existed; the habit didn't.
Mark
Under one percent sounds almost like the tool wasn't used at all. Why does that matter?
Mimi
Because it was available to all 69 clinicians in a trial, and still opened in only 959 of 145,511 visits. The tool existed; the habit didn't.
Mark
But when did people use it?
Mimi
When it fit the visit. Chronic pain diagnoses and long-term opioid patients pushed use up, by about 3.5 and 4.7 percentage points. New patients pushed it down.
Luke
Those are still small absolute numbers, though. A 4.7 point rise from a base under one percent is not a tool becoming routine.
Mimi
Fair. It shows where use concentrates, not that it's widespread.
Mark
And the gender and experience finding?
Mimi
The patterns were strongest among female clinicians with over 16 years in practice.
Luke
Careful with why. The study measured who used it, not their reasons. The explanations about documentation burden come from prior literature on EHR use, not from this data.
Mark
So what's actually established?
Luke
The usage pattern from audit logs. The motives are the authors' hypothesis. Also, prior use didn't predict later use, which is interesting but the interval is borderline.
Mimi
And social influence and workplace support weren't measured at all, so those remain open.
Il Polso
- Clinicians opened the OneSheet pain tool in only 959 of 145,511 encounters, a sliver of the visits it was meant to serve.
- The tool gathers guideline details and shortcuts into one chart view, yet many clinicians never reached for it.
- Use climbed for chronic pain diagnoses and long-term opioid patients, while new patients drew it back.
- Experienced female clinicians responded most strongly, pointing to uneven pressures of time, documentation and messaging.
- The authors urge designers to make tools clinically relevant and tailored to clinician diversity rather than merely available.
Across a stream of nearly a hundred and fifty thousand primary care visits, a tool meant to steady the hand of clinicians facing chronic pain was reached for in fewer than one visit in a hundred. The finding, set down in PLOS Digital Health in July 2026, reminds us that a helpful instrument does not help simply by existing; it must meet the particular person, the particular patient and the particular moment. The quiet patterns beneath the number, shaped by who the patient is and who the clinician has become, suggest that adoption is less a matter of distribution than of fit.
Across 145,511 primary care visits in a randomized trial at two health systems, clinicians opened a chronic pain tool called OneSheet in just 959 of them, about 0.7 percent. The tool pulls guideline-relevant information, such as pain diagnoses and function goals, into one view in the electronic health record, and offers shortcuts like ordering urine drug screens. For opioid prescribing, where monitoring data must be reviewed, that consolidation could save real time.
The study, led by Erin McCord with colleagues including Nate Apathy and Christopher Harle, drew on audit logs from October 2019 to May 2022 involving 69 clinicians. Logs capture what clinicians actually did, rather than what they later recalled, which matters because surveys on decision support have often been unreliable. Use rose for visits involving chronic pain diagnoses and long-term opioid therapy, and fell for new patients. Prior use did not predict future use.
The strongest patterns appeared among female clinicians with more than 16 years in practice. The authors drew on the Unified Theory of Acceptance and Use of Technology, which links adoption to perceived usefulness and ease of use. A specialized tool may feel useful to some clinicians and not others, and less experienced clinicians may favor tools that apply to nearly every visit. Prior work also shows female clinicians carrying heavier documentation, after-hours work and message loads, which may shape how they spend their limited attention.
The authors' conclusion is that supplying a tool is not enough. Adoption depends on clinical relevance to the visit at hand, and on training, workflow and design that account for the range of people who will use it. The next step is tailored implementation built on these patterns.
Across 145,511 primary care visits, a tool built to help clinicians manage chronic pain was opened in 959 of them. That is 0.7 percent. The figure comes from a study published July 16, 2026 in PLOS Digital Health, led by Erin McCord and colleagues including Nate Apathy, Justin Blackburn, Ann Holmes, Lindsey Sanner and Christopher Harle.
The tool is called OneSheet, a form of clinical decision support, or CDS. It pulls guideline-relevant information, such as pain diagnoses and pain and function goals, into a single view in the electronic health record. It also offers shortcuts to recommended actions, such as ordering urine drug screens. The idea is that a clinician no longer has to hunt through several sections of the chart. For opioid prescribing, where clinicians must review prescription drug monitoring program data, that consolidation could save time.
The data came from a pragmatic randomized controlled trial run at two health systems and covering October 2019 to May 2022. The study included 69 primary care clinicians who had access to OneSheet for chronic non-cancer pain. The researchers counted a visit as a use if the clinician opened OneSheet within three days before or after the encounter. Because the data came from electronic health record audit logs, they reflect what clinicians did rather than what they said they did. Earlier research on CDS has leaned heavily on surveys, which the authors note are prone to recall and social desirability bias.
Use was not evenly spread. Visits with new patients were less likely to involve OneSheet, by 0.42 percentage points. Visits where the patient had a chronic pain diagnosis were 3.48 percentage points more likely to involve it. Visits with a patient on long-term opioid therapy were 4.70 percentage points more likely. Prior use did not predict future use: the estimate for that effect was 0.30 percentage points, with a confidence interval that ran from roughly zero to 0.06.
The second layer of the analysis looked at who was using the tool. The authors tested whether clinician gender and years in practice changed how patient characteristics translated into use. The patterns were strongest among female clinicians with more than 16 years in practice.
The authors framed the work with the Unified Theory of Acceptance and Use of Technology, which holds that perceived usefulness and ease of use drive adoption. They could examine those two constructs with audit logs. Two others, social influence and facilitating conditions, could not be measured with the available data and were left out. They reasoned that a specialized tool may seem useful to some clinicians and not others. Less experienced clinicians may focus on tools that apply to nearly every visit, such as drug-interaction alerts. Cited work on electronic health record use also shows female clinicians spending more time on documentation and after-hours tasks and handling more messages, which they suggest could shape how they use CDS.
Their conclusion is that supplying a tool is not enough. Adoption depends on whether the tool is clinically relevant to the visit at hand, and on designing training, workflow integration and the tool itself with the range of clinicians in mind. The study was funded by the National Institute on Drug Abuse. Harle reports research grants to his employer related to chronic pain CDS, and consulting for Pfizer unrelated to this work. The next step is applying these patterns to tailored implementation.
Citazioni salienti
Simply providing CDS tools is not enough; adoption efforts must ensure clinical relevance and consider clinician diversity.— McCord et al., PLOS Digital Health (paraphrase)
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