OP0144 SLE-T2T – A DIGITAL TREAT-TO-TARGET CLINICAL DECISION SUPPORT SYSTEM FOR THE MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: DEVELOPMENT AND USABILITY EVALUATION

Abstract

Treating-to-target (T2T), a treatment approach focussed on achieving a specific goal by stepwise changes in treatment, is a well-established strategy in various diseases and has been proposed for systemic lupus erythematosus (SLE)1. However, the implementation of such strategies has been shown to be difficult in practice with low clinician adherence2. Clinical decision support systems (CDSS) are designed to assist health care professionals in their decision-making process3. SLE-T2T is an online CDSS tool designed to help rheumatologists to apply a T2T strategy in the management of SLE patients.We aimed to design and develop a first prototype of SLE-T2T, and test its usability for the implementation of a treat-to-target strategy in the management of patients with SLE.The creation process was composed of three phases: first, SLE-T2T was conceived as a web-based application with a specific task - to generate appropriate treatment advice based on entered patients’ data. A general sketch of the program was made, and general consensus was achieved with regards to the desired functionalities. In the development phase, a beta version of SLE-T2T was conceived using a free integrated development environment, and based on Javascript, HTML and CSS. After, the system was hosted temporarily on the website of the Amsterdam Rheumatology & Immunology Center4, to be accessible for the participants in evaluation phase. Finally, a System Usability Score survey (SUS)5,6 was chosen as the usability test tool, given its simplicity and advantages; coupled with unstructured feedback about areas of improvement, collected from the participants using the “think aloud” method to determine whether the CDSS was user-friendly, comprehensible, easy-to-deliver, and workflow-oriented.The SLE-T2T web-based system was developed, consisting of: (1) an input scheme with the set of indexes and scores existing for the measurement of SLE disease activity (cSLEDAI-2K, SLEDAI-2K, PGA score) as well as the patients’ medication; (2) a rule-based interface that collects and processes patients’ data, and (3) an output dashboard with the generated set of recommendations tailored for the patients clinical state and aiming to reach a pre-stablished target of treatment (Figure 1). In the interim usability and acceptance evaluation, 7 participants completed the SUS survey. The mean usage time for SLE-T2T was 8 minutes. On a scale of 0 (worst) to 100 (best), the median SUS score of SLE-T2T was 79, categorizing the application as ‘good’ and indicating the need for minor improvements to the design necessary to reach a final version for later implementation in a treat-to-target pilot study.Figure 1.Overview of SLE-T2T CDSS tool. a. Architecture of the SLE-T2T app. b. Desktop and mobile example views.To the best of our knowledge, SLE-T2T is the first eHealth tool to be designed for the management of SLE patients in a treat-to-target context. The SUS score and unstructured feedback showed high acceptance of this digital instrument.[1]van Vollenhoven RF, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. 2014 Jun;73(6):958-67. doi: 10.1136/annrheumdis-2013-205139. Epub 2014 Apr 16.[2]Lugtenberg M, Zegers-van Schaick JM, Westert GP, Burgers JS. Why don’t physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci 2009; 4: 54.[3]Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med 2020; 3: 17.[4]https://ams-rc.com/[5]Brooke, J. 1996. “SUS: A “quick and dirty” usability scale”. In Usability evaluation in industry, Edited by: Jordan, P. W., Thomas, B. A. Weerdmeester and McClelland, I. L. 189–194. London: Taylor & Francis.[6]Lewis, James. (2006). Usability Testing. 10.1002/0470048204.ch49.The work of A.R.P.S. is supported by the European Union’s Horizon 2020 research and innovation programme support for the Amsterdam Rheumatology Centre for Autoimmune Diseases (ARCAID; grant number 847551).The development phase of SLE-T2T was made possible thanks to the partnership with 2nd year students from the University of Amsterdam Medical Informatics Bachelor’s program.Agner Parra Sanchez Grant/research support from: AstraZeneca, Employee of: AstraZeneca, Max G. Grimberg: None declared, Myrthe M.A. Hanssen: None declared, Moon O. Aben: None declared, Elianne E. Jairth: None declared, Prishent S. Dhoeme: None declared, Michel Tsang-A-Sjoe: None declared, Alexandre Voskuyl Speakers bureau: GSK, Consultant of: GSK, AstraZeneca, Roche, Grant/research support from: GSK, UCB, Jan Hendrik Leopold: None declared, Ronald van Vollenhoven Speakers bureau: AbbVie, Galapagos, GSK, Janssen, Pfizer, R-Pharma, UCB, Consultant of: AbbVie, AstraZeneca, Biogen, BMS, Galapagos, Janssen, Miltenyi, Pfizer, UCB, Grant/research support from: BMS, GSK, UCB