Development and implementation of a clinical decision support system tool for the evaluation of suspected monkeypox infection

Abstract

Monkeypox virus was historically rare outside of West and Central Africa until the current 2022 global outbreak, which has required clinicians to be alert to identify individuals with possible monkeypox, institute isolation, and take appropriate next steps in evaluation and management. Clinical decision support systems (CDSS), which have been shown to improve adherence to clinical guidelines, can support frontline clinicians in applying the most current evaluation and management guidance in the setting of an emerging infectious disease outbreak when those guidelines are evolving over time. Here, we describe the rapid development and implementation of a CDSS tool embedded in the electronic health record to guide frontline clinicians in the diagnostic evaluation of monkeypox infection and triage patients with potential monkeypox infection to individualized infectious disease physician review. We also present data on the initial performance of this tool in a large integrated healthcare system.

Keywords: CDSS; HCID; PUI; clinical decision support systems; high-consequence infectious disease; monkeypox; person under investigation.

Figure 1.

Care settings in which the MPX CDSS tool was used. The distribution of care settings in which the tool was utilized during its first 6 weeks of implementation is shown. CDSS: clinical decision support system; ID: infectious diseases; MPX: Monkeypox.

Figure 2.

Trends in use of the MPX CDSS tool. Bars depict the number of patients for whom the tool was used (total use), the number of possible PUIs identified by the tool (CDSS PUI), the number of possible PUIs in whom testing was pursued after expert review (Testing Pursued), and the number of patients who tested positive (MPX positive) during each of the first 6 weeks of implementation. CDSS: clinical decision support system; MPX: Monkeypox; PUI: person under investigation.

Figure 3.

Versioning of the MPX CDSS tool. The timeline showing major milestones prompting development of the MPX CDSS tool (eg, first diagnosed case at MGH on May 18, 2022), followed by request for development and implementation within 24 h of request on June 8, 2022. The top half of the timeline describes multiple changes to the PUI definition and IC protocols, while the bottom half describes versioning related to changes in the CDS to allow for more efficient collection of pertinent patient information, as well as ensuring access by clinicians to the most up to date public health guidance and local points of contact. CDC: Centers for Disease Control and Prevention; CDSS: clinical decision support system; IC: infection control; MPX: Monkeypox; PUI: person under investigation.