Web-based eHealth Clinical Decision Support System as a tool for the treat-to-target management of patients with systemic lupus erythematosus: development and initial usability evaluation

Abstract

Background: Treat-to-target (T2T) is a therapeutic strategy currently being studied for its application in systemic lupus erythematosus (SLE). Patients and rheumatologists have little support in making the best treatment decision in the context of a T2T strategy, thus, the use of information technology for systematically processing data and supporting information and knowledge may improve routine decision-making practices, helping to deliver value-based care.

Objective: To design and develop an online Clinical Decision Support Systems (CDSS) tool "SLE-T2T", and test its usability for the implementation of a T2T strategy in the management of patients with SLE.

Methods: A prototype of a CDSS was conceived as a web-based application with the task of generating appropriate treatment advice based on entered patients' data. Once developed, a System Usability Score (SUS) questionnaire was implemented to test whether the eHealth tool was user-friendly, comprehensible, easy-to-deliver and workflow-oriented. Data from the participants' comments were synthesised, and the elements in need for improvement were identified.

Results: The beta version web-based system was developed based on the interim usability and acceptance evaluation. 7 participants completed the SUS survey. The median SUS score of SLE-T2T was 79 (scale 0 to 100), categorising the application as 'good' and indicating the need for minor improvements to the design.

Conclusions: SLE-T2T is the first eHealth tool to be designed for the management of SLE patients in a T2T context. The SUS score and unstructured feedback showed high acceptance of this digital instrument for its future use in a clinical trial.

Keywords: decision support systems, clinical; disease management; medical informatics; outcome assessment, health care.

Figure 1

Overview of SLE-T2T CDSS tool architecture. cSLEDAI-2k, Clinical Systemic Lupus Erythematosus Disease Activity Index 2000; PGA: Physician Global Assessment; SLEDAI-2K, SystemicLupus Erythematosus Disease Activity Index 2000.

Figure 2

Desktop view screenshots of the SLE-T2T web-based application (Amsterdam UMC, all rights reserved). (A) Home page. (B) Sequence of screenshots following the evaluation process, as follow: 1. SLEDAI-2K checklist; 2. PGA visual scale from 0 to 3; 3. patient’s current medication list, divided in antimalarial, immunosuppressive therapy (including biologics) and glucocorticoids (prednisolone dosage); 4. target selection page, among remission and LLDAS; 5. output page, describing the recommendations. LLDAS: Lupus Low Disease Activity State; PGA: Physician Global Assessment; SLEDAI-2K, Systemic Lupus Erythematosus Disease Activity Index 2000.