New tool guides clinicians to identify and treat patients at risk for monkeypox virus

BOSTON- Monkeypox was rarely seen outside of West and Central Africa until the current global outbreak in 2022, and clinicians are now on high alert to identify, isolate and treat those infected with the virus who is the cause. A team led by researchers at Massachusetts General Hospital (MGH) recently developed and implemented a clinical decision support system to aid in this effort.

As described in a study published in the Journal of the American Medical Informatics Associationthe Monkeypox Clinical Decision Support Tool (MPX-CDSS) is integrated with the electronic health record to guide front-line clinicians who can access it by typing “.MONKEYPOX” in any inpatient or outpatient note .

Clinicians are given a structured set of screening questions adapted from the US Centers for Disease Control and Prevention, and depending on clinician responses, a second set of questions may request more individualized risk data for each patient.

Clinicians are also encouraged to upload images of the patient’s rash to the electronic health record for review by infectious disease and public health officials. The tool includes guidelines for immediate infection control protocols.

In June 2022, MPX-CDSS was launched in Mass General Brigham, a large integrated healthcare system in Massachusetts and New Hampshire that includes MGH, 8 acute care hospitals, 2 specialty hospitals, and an extensive post-acute care network, from community and primary health. care centers. In the first 6 weeks, the tool was used 55 times to assess monkeypox infection across the healthcare system.

During this period, several updates have been made to capture the evolution of definitions, collect information and make the tool easier to use. “The decision support tool was quickly implemented and allowed for frequent iterations with input from subject matter experts based on evolving epidemiological risk factors and testing strategies to improve the ‘effectiveness of diagnostic assessment,’ says lead author Erica S. Shenoy, MD, PhD, chief associate of the MGH’s Infection Control Unit and assistant professor of medicine at Harvard Medical School.

Lead author John Albin, MD, PhD, Infectious Disease Instructor at the MGH adds that tools such as the MPX-CDSS can be quickly adapted to changing circumstances, allowing frontline providers to use the best information available. to manage patients during an evolving epidemic. “I hope similar tools can help expand the response to future emerging infectious diseases and promote structured assessments that lend themselves to systematic evaluation and improvement of clinical care.”

In their study, Albin and colleagues describe the development, implementation, and early usage patterns of MPX-CDSS. However, they have not evaluated its sensitivity or specificity to accurately identify monkeypox cases, and further large-scale analyzes will be needed to determine its value during the monkeypox outbreak and for similar approaches during other infectious disease outbreaks.

“Decision support is a powerful tool that can support patient care during an emerging infectious disease outbreak. Since its release, further enhancements to the tool have been made to support documentation of infection resolution for confirmed monkeypox patients to release individuals from isolation,” says Shenoy.

Additional co-authors include Jacob E. Lazarus, Kristen M. Hysell, David M. Rubins, Lindsay Germaine, Caitlin M. Dugdale, Howard M. Heller, Elizabeth L. Hohmann, and Joshua J. Baugh.

This work was supported by the United States Assistant Secretary for Preparedness and Response.

About Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is Harvard Medical School’s first and largest teaching hospital. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and includes more than 9,500 researchers working in more than 30 institutes, centers and departments. In June 2022, Mass General was named No. 5 in the US News and World Report list of “America’s Best Hospitals”. MGH is a founding member of the Mass General Brigham Health System.

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