Separating the rash from the chaff: novel clinical decision support deployed during the mpox outbreak

Abstract

A clinical decision support system, EvalMpox, was developed to apply person under investigation (PUI) criteria for patients presenting with rash and to recommend testing for PUIs. Of 668 patients evaluated, an EvalMpox recommendation for testing had a positive predictive value of 35% and a negative predictive value of 99% for a positive mpox test.

Figure 1.

From the top left, EvalMpox guides clinicians to sample images of mpox rashes and guides history taking to allow a standardized collection of information on rash onset, location, qualities, and associated systemic symptoms. It also prompts the clinician to document the rash photographically to assist in the evaluation of rash evolution over time. This standardized approach also accomplishes clinician teaching on features of this unfamiliar disease and ensures evaluation for signs or symptoms that may not be part of a routine evaluation (eg, pharyngitis, proctitis). From the top right, risk factor identification assists with contact tracing. By collecting information on challenges to discharge home, EvalMpox facilitates early involvement of in-house case management and Department of Public Health input. For patients classified as PUI, EvalMpox provides local site contact information to assist HCW in patient triage and testing. Finally, EvalMpox automatically coordinates the application of mpox-related infection statuses and isolation. Example screenshot from Epic^™ (Epic Systems Corporation). Note: HCW, healthcare workers