The Development of a Proof-of-Concept Physician-Driven Informatics Consult System for the Individualized Treatment of Patients with Orthopaedic Conditions

Abstract

Abstract Background: The diversity and variation of patient data now increasingly documented in Electronic Health Record (EHR) systems can be used to generate evidence about which treatments work and for whom they work. The objective of this work was to demonstrate proof-of-concept of a physician-driven informatics consult system which can drive improvements in the quality and safety of orthopaedic care. The informatics consult system allows for physicians to perform dynamic searches and receive immediate data summaries of similar, previously treated patients at the point of care. As a first use case, we apply our informatics consult prototype to the treatment of acute proximal humerus fractures (PHF). Methods: We used an EHR-based, simulated patient data file to develop the informatics consult system prototype, ICSCEDIT (Informatics Consult System for Comparative Effectiveness Data for Individualized Treatment). We developed a user interface for physicians to define similar patient groups or reference classes, and we use comparative effectiveness research methodology and visual analytics to summarize outcomes for patients under treatment alternatives. Candidate wireframes were reviewed by the research and clinical team members in iterative user experience phases, each phase employing 1) prototype design and demonstration, 2) collection and documentation of expert/user feedback, and 3) prototype redesign based on feedback. Results: ICSCEDIT was designed with a series of patient characteristic filters that can be applied to subset historical patient records into similar cohorts matching the index patient of interest. A total of 14 patient filters across demographic, fracture characteristics, and patient comorbidities are included. The evidence for patient reference classes, displayed by treatment group, appears in a series of three tabs. The first tab displays treatment rates of initial surgery and conservative management for the reference class. The second tab contains summaries of patient-reported outcome measures presented by treatment group and the third tab displays summaries of healthcare utilization over the year following the PHF injury. Conclusion: We describe a prototype of an informatics consult system for orthopaedic medicine. Informatics consult systems that enable learning from historical treatment decisions and outcomes holds great potential for improving the quality of care for all orthopaedic patients.