Assessing the use of a clinical decision support tool for pain management in primary care
Open accessAbstract
Objective: Given time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial. Materials and methods: The tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals. Results: Overall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9–32]; site 2: median: 8 [IQR 5–16]). Seven “power users” accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites. Discussion: Modest OneSheet use was observed relative to the number of eligible patients seen with chronic pain. Conclusions: Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows.
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Organizations implementing clinical decision support tools in primary care are likely to see considerable provider-level variation in usage because of differences in provider and care team workflows.
“Apathy etal. reported in a study of real-world usage of CDS in primary care that organizations implementing such tools are likely to see considerable provider-level variation in usage because of differences in provider and care team workflows.”
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Cites
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · JAMA · doi:10.1001/jama.2016.1464 · Cited by 5,161 · see citing works
Empirical Evaluation of the Revised Technology Acceptance Model
Szajna, B. (1996) · Management Science · doi:10.1287/mnsc.42.1.85 · Cited by 1,656 · see citing works
Krebs, E. E., Lorenz, K. A., Bair, M. J., Damush, T. M., Wu, J., Sutherland, J. M., Asch, S. M., & Kroenke, K. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-0981-1 · Cited by 782 · see citing works
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M., Payne, T. H., Rosenbloom, S. T., Weaver, C., & Zhang, J. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2012-001458 · Cited by 618 · see citing works
Clinical Decision-Support Systems
Musen, M. A., Blackford Middleton, A., & Greenes, R. A. (2013) · Springer eBooks · doi:10.1007/978-1-4471-4474-8_22 · Cited by 577 · see citing works
Improving Outcomes with Clinical Decision Support: An Implementer's Guide, Second Edition
Osheroff, J. (2012) · doi:10.4324/9781498757461 · Cited by 517 · see citing works
Some unintended consequences of clinical decision support systems.
Ash, J. S., Sittig, D. F., Campbell, E. M., Guappone, K. P., & Dykstra, R. H. (2007) · PubMed Central · Cited by 298 · see citing works
Information Chaos in Primary Care: Implications for Physician Performance and Patient Safety
Beasley, J. W., Wetterneck, T. B., Temte, J. L., Lapin, J. A., Smith, P. D., Rivera-Rodriguez, A. J., & Karsh, B.-T. (2011) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2011.06.100255 · Cited by 242 · see citing works
Embi, P. J., & Leonard, A. C. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000743 · Cited by 199 · see citing works
Patients Treated at Multiple Acute Health Care Facilities: Quantifying Information Fragmentation
Bourgeois, F. C. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.439 · Cited by 140 · see citing works
Cohen, G. R., Friedman, C. P., Ryan, A. M., Richardson, C. R., & Adler-Milstein, J. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05025-3 · Cited by 117 · see citing works
Matthias, M. S., Johnson, N. L., Shields, C. G., Bair, M. J., MacKie, P., Huffman, M. A., & Alexander, S. C. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.06.008 · Cited by 114 · see citing works
Trafton, J. A., Martins, S. B., Michel, M., Lewis, E. T., Wang, D., Combs, A., Scates, N., Tu, S. W., & Goldstein, M. K. (2010) · Pain Medicine · doi:10.1111/j.1526-4637.2010.00818.x · Cited by 106 · see citing works
The five "rights" of clinical decision support.
Campbell, R. J. (2013) · PubMed · Cited by 100 · see citing works
Patient-Centered Reduction or Discontinuation of Long-term Opioid Analgesics
Dowell, D., Compton, W. M., & Giroir, B. P. (2019) · JAMA · doi:10.1001/jama.2019.16409 · Cited by 99 · see citing works
Elwyn, G. J., Pickles, T., Edwards, A., Kinsey, K., Brain, K. E., Newcombe, R. G., Firth, J., Marrin, K., Nye, A., & Wood, F. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.10.011 · Cited by 89 · see citing works
Lin, H., Wang, Z., Boyd, C. J., Simoni, J. M., & Buu, A. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.08.032 · Cited by 87 · see citing works
Trafton, J. A., Martins, S. B., Michel, M., Wang, D., Tu, S. W., Clark, J. D., Elliott, J., Vucic, B., Balt, S., Clark, M. E., et al. (2010) · Implementation Science · doi:10.1186/1748-5908-5-26 · Cited by 65 · see citing works
Apathy, N. C., Holmgren, A. J., & Adler-Milstein, J. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocab102 · Cited by 56 · see citing works
Self-citationThe Five Rights of Clinical Decision Support: CDS Tools Helpful for Meeting Meaningful Use
Campbell, R. J. (2013) · Journal of AHIMA · Cited by 55 · see citing works
Early Changes in Billing and Notes After Evaluation and Management Guideline Change
Apathy, N. C., Hare, A. J., Fendrich, S. J., & Cross, D. A. (2022) · Annals of Internal Medicine · doi:10.7326/m21-4402 · Cited by 54 · see citing works
Self-citationAnderson, D., Zlateva, I., Khatri, K., & Ciaburri, N. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000177 · Cited by 51 · see citing works
Sperl‐Hillen, J. M., Rossom, R. C., Kharbanda, E. O., Gold, R. B., Geissal, E. D., Elliott, T. E., DESAI, J. R., Rindal, D. B., Saman, D. M., Waring, S. C., et al. (2019) · eGEMs (Generating Evidence & Methods to improve patient outcomes) · doi:10.5334/egems.284 · Cited by 45 · see citing works
Decision support from local data: Creating adaptive order menus from past clinician behavior
Klann, J. G., Peter Szolovits, B., Downs, S. M., & Schadow, G. (2013) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2013.12.005 · Cited by 38 · see citing works
A better approach to opioid prescribing in primary care.
Canada, R. E., DiRocco, D., & Day, S. C. (2014) · PubMed · Cited by 29 · see citing works
Spithoff, S., Mathieson, S., Sullivan, F., Guan, Q., Sud, A., Hum, S., & O'Brien, M. A. (2020) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2020.04.190199 · Cited by 25 · see citing works
Patel, S. A., Carmichael, J. M., Taylor, J. M., Bounthavong, M., & Higgins, D. T. (2017) · Annals of Pharmacotherapy · doi:10.1177/1060028017739388 · Cited by 20 · see citing works
Factors That Influence Changes to Existing Chronic Pain Management Plans
Diiulio, J., Militello, L. G., Andraka‐Christou, B., Cook, R. L., Hurley, R. W., Downs, S. M., Anders, S. H., Mamlin, B. W., Danielson, E. C., & Harle, C. A. (2020) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2020.01.190284 · Cited by 20 · see citing works
Self-citationMilitello, L. G., Hurley, R. W., Cook, R. L., Danielson, E. C., Diiulio, J., Downs, S. M., Anders, S. H., & Harle, C. A. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06178-2 · Cited by 19 · see citing works
Self-citationDecision-Centered Design of Patient Information Visualizations to Support Chronic Pain Care
Harle, C. A., Diiulio, J., Downs, S. M., Danielson, E. C., Anders, S. H., Cook, R. L., Hurley, R. W., Mamlin, B. W., & Militello, L. G. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1696668 · Cited by 18 · see citing works
Self-citationThe effect of EHR-integrated patient-reported outcomes on satisfaction with chronic pain care.
Harle, C. A., Marlow, N. M., Schmidt, S. O., Shuster, J. J., Listhaus, A., Fillingim, R. B., & Hurley, R. W. (2016) · PubMed · Cited by 16 · see citing works
Self-citationHarle, C. A., Apathy, N. C., Cook, R. L., Danielson, E. C., Diiulio, J., Downs, S. M., Hurley, R. W., Mamlin, B. W., Militello, L. G., & Anders, S. H. (2018) · Europe PMC (PubMed Central) · Cited by 14 · see citing works
Self-citationDanielson, E. C., Mazurenko, O., Andraka‐Christou, B., Diiulio, J., Downs, S. M., Hurley, R. W., & Harle, C. A. (2019) · MDM Policy & Practice · doi:10.1177/2381468319892572 · Cited by 13 · see citing works
Self-citationDanielson, E. C., Harle, C. A., Downs, S. M., Militello, L. G., & Mazurenko, O. (2021) · Journal of Opioid Management · doi:10.5055/jom.2021.0684 · Cited by 9 · see citing works
Self-citationBinswanger, I. A., Joseph, N., Hanratty, R. L., Gardner, E. M., Durfee, J., Narwaney, K. J., Breslin, K. D., Mueller, S. R., & Glanz, J. M. (2018) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2018.09.005 · Cited by 6 · see citing works
A Statistical Approach for the Learning Curve of Physicians in Utilization of Electronic Order Sets
Lee, J., & Hulse, N. C. (2019) · Methods of Information in Medicine · doi:10.1055/s-0039-1700540 · Cited by 1 · see citing works
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Research works printed but not linked: 1
- [11]Gatchel RJ, Turk DC, eds. Psychosocial Factors in Pain: Critical Perspectives. New York, NY: The Guilford Press; 1999.
Cited by
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Price-Haywood, E. G., Burton, J. H., Harden-Barrios, J., Bazzano, A., Shi, L., Lefante, J., & Jamison, R. N. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-08965-7 · Cited by 2 · see citing works
- Authors
- Apathy, N. C., Sanner, L., Adams, M. C. B., Mamlin, B. W., Grout, R. W., Fortin, S., Hillstrom, J., Saha, A., Teal, E., Vest, J. R., Menachemi, N., Hurley, R. W., Harle, C. A., & Mazurenko, O.
- Affiliations
- Regenstrief Institute (US)
- Indiana University Indianapolis (US)
- Wake Forest University Health Sciences (US)
- Primary Care, Eskenazi Health , Indianapolis, Indiana, USA
- Eskenazi Health (US)
- Corresponding author
- Mazurenko, Olena
- ORCID
- Venue
- JAMIA Open
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-07-11
- Volume
- 5
- Issue
- 3
- Pages
- ooac074-ooac074
- ISSN
- 2574-2531 (ISSN-L)
- PMC
- PMC9476612
- OpenAlex
- W4295941097
- Cited by
- 9
- References
- 36
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 2
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- JAMIA Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc)
- Funders
- National Institutes of Health (R33DA046085)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- clinical decision support, chronic non-cancer pain, pain management, primary care, electronic health records, user-centered design, guideline adherence, patient-reported pain
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