Although clinical decision support systems have been shown to improve patient safety, clinicians do not always use these tools or follow recommendations. Investigators conducted interviews with physicians, nurses, technology staff, and board members regarding their experiences with clinical decision support systems. Through qualitative analysis, they identified a concern about loss of physicians' decision-making autonomy as a barrier to decision support use. Even interviewees who supported decision support in principle described challenges related to technical and usability shortcomings. The authors suggest that a transparent and accountable organizational culture is needed for successful implementation of clinical decision support. A WebM&M commentary discussed how structured diagnostic assessments can be augmented by decision support.