Health Tech Without Borders Global Health Survey Series
Clinical Decision Support Tools: Breadth of Use and User Satisfaction
Sept 2025
EXECUTIVE SUMMARY
This report summarizes a 2025 cross-sectional survey of over 1,000 clinicians worldwide, examined the frequency of usage and satisfaction with evidence-based clinical reference platforms. The study, conducted by M3 Global Research for Health Tech Without Borders, Inc. with the support of Digital Health New York and the City University of New York (CUNY) School of Public Health Foundation, contributes valuable data for health tech leaders, digital health pioneers, and clinicians seeking to
understand the evolving healthcare technology landscapes.
KEY FINDINGS
UpToDate is the leading medical reference across the United States and the world, with MDCalc and Medscape being reported second and third. The new generative AI tool OpenEvidence shows increasing usage.
METHODOLOGY
The study surveyed approximately 1,000 non-surgical, English-speaking clinicians across the United States (US), international (“non-US”) markets, and worldwide (defined as US plus non-US combined). Respondents represented approximately 85% physicians and 15% other providers including physician assistants and nurse practitioners. M3 Global Research, a leading clinician survey company, conducted the survey, supported by DHNY and the CUNY School of Public Health Foundation with Health Tech Without Borders. Data was collected over the first half of 2025, with respondents requiring active clinical practice involving at least 30 hours of patient interaction per week.
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Bain Consulting’s Net Promotor Score (NPS) was utilized to quantitatively evaluate the user’s satisfaction with each tool, on a 0–10 scale, with the standard NPS calculation applied. The survey investigated whether respondents would recommend a reference tool to a colleague for supporting clinical decision-making.
FINDINGS: BREADTH OF USE
The survey revealed a substantial level of engagement with the digital reference tools surveyed. A large proportion of respondents utilized digital resources monthly, indicating a growing integration of these tools into clinical workflows. UpToDate emerged as the most broadly utilized reference tool across all categories. MDCalc ranked second, demonstrating substantial adoption rates. Medscape ranked third globally.
Beyond these leading tools, PubMed was the most common additional tool used by clinicians that was suggested in free text comments (11% of respondents). All other free text responses accounted for 3% or less of total responses, suggesting that the survey had appropriately identified the most relevant tools used by clinicians.
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In evaluating how clinicians came to access the tools, respondents were asked how they engaged with the various clinical decision tools. Some tools relied primarily on clinicians initiating contact, while others employed supplementary strategies such as emails and social media campaigns to maintain engagement. UpToDate, MDCalc, DynaMed, and ClinicalKey relied heavily on user discovery and organic engagement, while Medscape, Epocrates, Doximity, and OpenEvidence actively employed email campaigns and social media to reach clinicians. Doximity is primarily only available in the US and we did not include it in the worldwide and non-US analysis.
USAGE IN THE UNITED STATES
UpToDate remains the leading reference tool in the US for clinical decision-making. It is used monthly by 86% of US clinicians. MDCalc also plays a critical role, with 61% of US clinicians using it monthly for clinical decision support, particularly for medical calculators and decision tools.
The increasing adoption of these tools could reflect the experience of clinicians who initially trained with these resources and are now in established mid-career roles. No other tool in our survey reached over 50% monthly active use.
USAGE OUTSIDE THE UNITED STATES
We observed robust usage of UpToDate internationally. The data shows a near statistical tie between UpToDate and MDCalc in non-US markets, with 73% of non-US clinicians using UpToDate and 69% using MDCalc monthly. Across all user groups, ClinicalKey achieved a notable 36% usage, while Epocrates and DynaMed reported rates of 33% and 25% respectively.
Overall, UpToDate and MDCalc are likely the most broadly used clinician references across the globe, both having existed for over 15 years. Notably, approximately one in four clinicians reported monthly use of OpenEvidence — a growing generative AI in medical decision-making.
FINDINGS BY SPECIALTY
Specialty-specific breadth of use was also calculated across multiple specialties; below is the report for the highest three references for six different specialties.
FINDINGS: USER SATISFACTION BY NET PROMOTER SCORE
Net Promoter Score was utilized to quantitatively assess user satisfaction, and our survey found a pronounced differentiation in reference tool satisfaction levels. Despite the limited number of tools achieving positive NPS scores, the data highlights a spectrum of user sentiment. Further analysis revealed a robust correlation between tool usage and satisfaction, suggesting opportunities for enhanced engagement and adoption among users of less-utilized resources.
** As Doximity is not primarily a clinical decision support tool, it was left out of the NPS calculation, which was centered around user satisfaction with regards to supporting clinical decisions.
The observed concentration of positive NPS scores among leading reference tools prompted a deeper investigation into the drivers of user satisfaction. While excitement surrounding generative AI’s application in clinical decision-making is evident, our data reveals a major degree of caution among clinicians. Notably, only UpToDate and MDCalc achieved positive NPS scores (60% and 52%, respectively). The remaining reference tools, including Medscape (-7%), Epocrates (-12%), DynaMed (-19%), ClinicalKey (-16%) and OpenEvidence (-9%) – yielded negative NPS scores, suggesting a substantial portion of clinicians hold reservations regarding these novel tools and continue to trust in legacy tools. This divergence in user sentiment warrants further exploration and is anticipated to close rapidly as comfort with these tools increases over time.
CONCLUSION
Our survey demonstrates that UpToDate, MDCalc, and Medscape are the most frequently accessed digital reference tools. These tools continue to be used regularly for everyday clinical decision-making across a broad range of specialties. Emerging generative-AI platforms continue to gain traction. We anticipate continued growth in adoption as advancements in data security, system errors, ethical governance, and human oversight further reinforce the safety and efficacy of these technologies in clinical environments. As these technologies advance, their potential to transform healthcare highlights the need for sustained development and responsible implementation.