Decision Support using the Clinical Development Kit
The Clinical Development Kit
TPP designed SystmOne’s Clinical Development Kit (CDK) to provide users with the flexibility to create their own clinical tools, tailored to their specific needs. As a no-code platform, clinicians can utilise the CDK to customise their experience using simple, user-friendly tools.
Protocols are one aspect of the CDK which allows users to design and trigger processes using data held within patients’ Electronic Health Record. Since the creation of SystmOne’s CDK, over 70,000,000 protocols have been triggered by users. The Pennine Musculoskeletal Partnership (PMSKP) and clinicians from Leeds Teaching Hospitals (LTH) have each recently utilised these protocols to produce clinical calculators.
The Pennine Musculoskeletal Partnership
PMSKP utilised the protocols within SystmOne’s Clinical Development Kit to produce a Disease Activity Score calculator for rheumatoid arthritis (DAS28 calculator). Designed using the core clinical development functionality accessible across all SystmOne modules, the DAS28 calculator saves time and increases clinical efficiency.
A DAS28 score reflects the activity or control of a patient’s rheumatoid arthritis and is used to determine the type of treatment required. In order to calculate a DAS28 score, clinicians require specific patient data, including the number of tender joints and swollen joints they are experiencing, a Patient Global Health Score and markers of inflammation (ESR or CRP). Usually clinicians would need to input all of the necessary patient data into a separate online DAS28 calculator to obtain a score, manually transferring data in and out of SystmOne to do so, using up vital clinical time.
The use of online DAS28 calculators also presents the potential risk of inaccuracy, as websites may have varying methods of implementing the calculating algorithm. This lack of standardisation allows for misleading variation in DAS28 scores which could negatively impact patient outcomes.
In response to these problems, PMSKP used SystmOne’s Clinical Development Kit to create a DAS28 calculator accessible via the toolbar. Katharine Kinsey, a Research Nurse at PMSKP, said: “Instead of having to re-enter data into a separate Disease Activity Score calculator, this protocol command pulls data through from the patient’s EHR, calculates the score, and saves it directly into the patient record. It avoids duplication, saves time, and increases data capture for assessing response to treatment. It has been a great addition to the system, as all of the Rheumatology team calculate Disease Activity on a daily basis.”
Being able to calculate and access the DAS28 score easily is essential for care providers to ensure that they are always aware of patients’ evolving needs and consistently providing the most appropriate care. Not only has this saved valuable time for PMSKP, who run over 600 clinics a month, it also demonstrates the potential of SystmOne’s core clinical development functionality.
“This protocol command…avoids duplication, saves time, and increases data capture…It has been a great addition to the system.”
Beyond building the tool, PMSKP were also able to use the CDK to tailor the calculator to meet their specific needs, by implementing a caveat within the protocol to prevent any data that is more than two weeks old from being used in the calculation.
There is also the potential to build more clinical decision support into protocols like the DAS28 calculator. For example, if the calculated DAS28 score is above a certain threshold, an information box could appear advising users to escalate the patient’s level of treatment. Alternatively, if the score is calculated below a certain threshold, an information box could appear advising clinicians to continue or lower the level of treatment.
Leeds Teaching Hospitals
Clinicians from Leeds Teaching Hospitals have also created protocols to calculate a Fibrosis-4 score (FIB-4). A FIB-4 score is used by clinicians to estimate the amount of scarring on a patient’s liver, which can be an indicator of illnesses like liver disease.
Usually, upon suspecting a patient may be at risk of liver disease, GPs would refer them to a hepatologist who would calculate the FIB-4 score. This creates an excess of unnecessary referrals as GPs are in fact capable of calculating the score themselves, as long as they have the required criteria, including age, AST, ALT, and platelet count.
These referrals use up vital clinical time and prolong the period between a patient’s initial appointment and treatment. As a result, several clinicians across LTH have made use of the CDK to create their own FIB-4 calculator. This will reduce unnecessary referrals and hospital trips for patients, ensuring that care is provided at the primary level as much as possible.
The protocol will alert users if the necessary information is not available within the patients record or is over a year old, prompting them to request pathology tests if this is the case. Once the calculator has produced the score, depending on the value, clinicians will be prompted with messages to aid in the support of their decision, such as suggestions to continue primary care treatment or request further testing. The use of the calculator by LTH’s Liver Unit will support their care of a population of over 10 million people.
“It was very useful to have quick and easy access to the FIB-4 calculator via the toolbar, rather than having to calculate the score manually” said Paul Glynn, a GP at Lingwell Croft Surgery in Leeds who initially trialled the calculator. “It was also helpful to have the option to link to the calculator in the clinical tools dropdown, as we do for things like Q risk.”
“The builder is a simple, no-code, point-and-click interface, so it empowers clinical staff as well as IT teams to build in the tailored decision support tools they need.”
Going Forward
Ben Lawman, Design and Analysis Lead for Secondary Care at TPP, said: “The calculators are particularly good examples of the CDK enabling advanced decision support, since they use protocol variables functionality which can pull any numeric data from the shared record and perform a range of calculations. The builder is a simple, no-code, point-and-click interface, so it empowers clinical staff as well as IT teams to build in the tailored decision support tools they need.”
SystmOne’s CDK allows users to build effective, comprehensive and adaptable tools to suit varied clinical needs. The FIB-4 and DAS28 calculators also offer broader benefits to the monitoring of population health. For example, it is possible for calculation requests to be automatically triggered for those patients who have potential risk factors or co-morbidities linked to relevant illnesses evidenced within their electronic health record.
The calculators produced by PMSKP and Leeds Teaching Hospitals Trust demonstrate the value of flexible, clinician-led tools provided by the Clinical Development Kit. TPP hopes that clinicians will continue to take advantage of this versatile tool in the future to build a more adaptable, dynamic, and comprehensive healthcare system.