1
|
Demuth S, Ed-Driouch C, Dumas C, Laplaud D, Edan G, Vince N, De Sèze J, Gourraud PA. Scoping review of clinical decision support systems for multiple sclerosis management: Leveraging information technology and massive health data. Eur J Neurol 2024:e16363. [PMID: 38860844 DOI: 10.1111/ene.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system, with numerous therapeutic options, but a lack of biomarkers to support a mechanistic approach to precision medicine. A computational approach to precision medicine could proceed from clinical decision support systems (CDSSs). They are digital tools aiming to empower physicians through the clinical applications of information technology and massive data. However, the process of their clinical development is still maturing; we aimed to review it in the field of MS. METHODS For this scoping review, we screened systematically the PubMed database. We identified 24 articles reporting 14 CDSS projects and compared their technical and software development aspects. RESULTS The projects position themselves in various contexts of usage with various algorithmic approaches: expert systems, CDSSs based on similar patients' data visualization, and model-based CDSSs implementing mathematical predictive models. So far, no project has completed its clinical development up to certification for clinical use with global release. Some CDSSs have been replaced at subsequent project iterations. The most advanced projects did not necessarily report every step of clinical development in a dedicated article (proof of concept, offline validation, refined prototype, live clinical evaluation, comparative prospective evaluation). They seek different software distribution options to integrate into health care: internal usage, "peer-to-peer," and marketing distribution. CONCLUSIONS This review illustrates the potential of clinical applications of information technology and massive data to support MS management and helps clarify the roadmap for future projects as a multidisciplinary and multistep process.
Collapse
Affiliation(s)
- Stanislas Demuth
- INSERM CIC 1434, Clinical Investigation Center, University Hospital of Strasbourg, Strasbourg, France
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
| | - Chadia Ed-Driouch
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
- Département Automatique, Productique et Informatique, IMT Atlantique, CNRS, LS2N, UMR CNRS 6004, Nantes, France
| | - Cédric Dumas
- Département Automatique, Productique et Informatique, IMT Atlantique, CNRS, LS2N, UMR CNRS 6004, Nantes, France
| | - David Laplaud
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
- Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Gilles Edan
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Nicolas Vince
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
| | - Jérôme De Sèze
- INSERM CIC 1434, Clinical Investigation Center, University Hospital of Strasbourg, Strasbourg, France
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre-Antoine Gourraud
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
- Data Clinic, Department of Public Health, University Hospital of Nantes, Nantes, France
| |
Collapse
|
2
|
Giovannoni G, Alvarez E, Tutton E, Hoffmann O, Xu Y, Vermersch P, Oreja-Guevara C, Trojano M, Gold R, Robles-Cedeño R, Khwaja M, Stadler B, Vandercappellen J, Ziemssen T. Development and usability testing of your MS questionnaire: A patient-based digital tool to monitor symptoms of multiple sclerosis. Digit Health 2023; 9:20552076231173531. [PMID: 37205165 PMCID: PMC10185975 DOI: 10.1177/20552076231173531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives We describe the development of Your Multiple Sclerosis Questionnaire and present the real-world usability testing results of Your Multiple Sclerosis Questionnaire. Methods The Your Multiple Sclerosis Questionnaire tool was developed in four stages to collect feedback from people living with MS (plwMS), patient organizations, and clinicians on content, format, and applicability. To assess its usability, 13 clinicians across 7 countries completed an online survey after using the tool with plwMS in a total of 261 consultations from September, 2020 to July, 2021. Results The initial Your Multiple Sclerosis Questionnaire version was based on findings from previous research developing MSProDiscuss™, a clinician-completed tool. Subsequently, insights from plwMS obtained during cognitive debriefing, patient councils and advisory boards led to changes including the addition of mood and sexual problems and the definition of relapse. All 13 clinicians completed the individual survey, whereas 10 clinicians completed the final survey. Clinicians "strongly agreed" or "agreed" that Your Multiple Sclerosis Questionnaire was easy to use and understand (98.5%; 257/261 patient consultations). The clinicians were willing to use the tool again with the same patient (98.1%; 256/261 patient consultations). All clinicians who completed the final survey (100%; 10/10) reported the tool to have a positive influence on their clinical practice, helped patients engage with their MS, facilitated discussion with patients, and complemented neurological assessment. Conclusion Your Multiple Sclerosis Questionnaire benefits both plwMS and clinicians by facilitating a structured discussion and engaging the plwMS to self-monitor and self-manage. Your Multiple Sclerosis Questionnaire is compatible with telemedicine practice and integration of the tool into electronic health records would enable tracking of the disease evolution and individual monitoring of MS symptoms over time.
Collapse
Affiliation(s)
- Gavin Giovannoni
- Blizard Institute, Barts and The London
School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Olaf Hoffmann
- Department of Neurology, Alexianer St
Josefs Hospital, Potsdam, Germany
- Brandenburg Medical School Theodor
Fontane, Neuruppin, Germany
| | - Yan Xu
- Multiple Sclerosis Center, Department
of Neurology, Peking Union Medical College Hospital, Peking Union Medical College,
Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Patrick Vermersch
- University of Lille, Inserm UMR U1172
LilNCog, CHU Lille, FHU Precise, Lille, France
| | | | - Maria Trojano
- Department of Basic Medical Science,
Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Ralf Gold
- Department of Neurology, St
Josef-Hospital/Ruhr-University Bochum, Bochum, Germany
| | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience,
Department of Neurology, Carl Gustav Carus University Clinic, Technische Universität
Dresden, Dresden, Germany
| |
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW This article provides an update on progressive forms of multiple sclerosis (MS) commonly referred to as primary progressive MS and secondary progressive MS. It discusses the importance of diagnosing and detecting progression early, the similarities between progressive forms, challenges in detecting progression, factors that could augment progression, and the importance of disease-modifying therapies in patients with evidence of active progressive MS. It also discusses the overall care of progressive MS. RECENT FINDINGS The pathogenesis of primary progressive MS and secondary progressive MS is overlapping, and in both presentations, patients with relapses or focal MRI activity are classified as having active, progressive MS. All currently approved disease-modifying therapies are indicated for active secondary progressive MS. The therapeutic opportunity of anti-inflammatory drugs for the treatment of progressive MS is enhanced in those who are younger and have a shorter disease duration. Vascular comorbidities may contribute to progression in MS. SUMMARY Several challenges remain in the diagnosis, follow-up, and treatment of progressive MS. Early identification of active progressive MS is needed to maximize treatment benefit. The advantages of optimal comorbidity management (eg, hypertension, hyperlipidemia) in delaying progression are uncertain. Clinical care guidelines for advanced, severe MS are lacking.
Collapse
|
4
|
Ziemssen T, Vandercappellen J, Jordan Mondragon V, Giovannoni G. MSProDiscuss™ Clinical Decision Support Tool for Identifying Multiple Sclerosis Progression. J Clin Med 2022; 11:jcm11154401. [PMID: 35956018 PMCID: PMC9369349 DOI: 10.3390/jcm11154401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 12/10/2022] Open
Abstract
This article describes the rationale for the development of the MSProDiscuss™ clinical decision support (CDS) tool, its development, and insights into how it can help neurologists improve care for patients with multiple sclerosis (MS). MS is a progressive disease characterized by heterogeneous symptoms and variable disease course. There is growing consensus that MS exists on a continuum, with overlap between relapsing–remitting and secondary progressive phenotypes. Evidence demonstrates that neuroaxonal loss occurs from the outset, that progression can occur independent of relapse activity, and that continuous underlying pathological processes may not be reflected by inflammatory activity indicative of the patient’s immune response. Early intervention can benefit patients, and there is a need for a tool that assists physicians in rapidly identifying subtle signs of MS progression. MSProDiscuss, developed with physicians and patients, facilitates a structured approach to patient consultations. It analyzes multidimensional data via an algorithm to estimate the likelihood of progression (the MSProDiscuss score), the contribution of various symptoms, and the impact of symptoms on daily living, enabling a more personalized approach to treatment and disease management. Data from CDS tools such as MSProDiscuss offer new insights into disease course and facilitate informed decision-making and a holistic approach to MS patient care.
Collapse
Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Clinic, Fetscherstraße. 74, 01307 Dresden, Germany
- Correspondence:
| | | | | | - Gavin Giovannoni
- Blizard Institute, The Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
| |
Collapse
|
5
|
Ziemssen T, Giovannoni G, Alvarez E, Bhan V, Hersh C, Hoffmann O, Oreja-Guevara C, Robles-Cedeño RR, Trojano M, Vermersch P, Dobay P, Khwaja M, Stadler B, Rauser B, Hach T, Piani-Meier D, Burton J. Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey. J Med Internet Res 2021; 23:e29558. [PMID: 34612826 PMCID: PMC8529467 DOI: 10.2196/29558] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs’ overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3% (6786/6974; initial) to 98.2% (269/274; final) of the cases. In 93.54% (6524/6974; initial) to 97.1% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76% initial and 252/274, 92% final) and cognitive function (5482/6974, 78.61% initial and 271/274, 79.2% final), as well as in discussing progression in general (6102/6974, 87.49% initial and 246/274, 89.8% final). While completing the final questionnaire, 94.9% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9%) and cognitive function (220/274, 80.3%). Overall, 92% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8% (235/274) were willing to integrate it into their clinical practice. Conclusions MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice.
Collapse
Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological University Clinic Carl-Gustav Carus, Dresden, Germany
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Enrique Alvarez
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Virender Bhan
- University of British Columbia, Vancouver, BC, Canada
| | - Carrie Hersh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Olaf Hoffmann
- Department of Neurology, St Josefs-Krankenhaus, Potsdam, Germany
| | | | - Rene R Robles-Cedeño
- Department of Neurology, Girona Neuroimmunology & Multiple Sclerosis Unit, Dr. Josep Trueta University Hospital & Santa Caterina Hospital, Girona, Spain
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Patrick Vermersch
- University of Lille, INSERM U1172, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, Lille, France
| | - Pamela Dobay
- Real World Evidence Solutions, IQVIA AG, Basel, Switzerland
| | | | | | | | | | | | - Jason Burton
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Perth, Australia
| |
Collapse
|
6
|
Inojosa H, Akgün K, Haacke K, Ziemssen T. [MSProDiscuss - Development of a Digital Anamnesis Tool to Identify Disease Progression in Multiple Sclerosis]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:374-381. [PMID: 33723837 DOI: 10.1055/a-1397-6851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
During the course of Multiple Sclerosis (MS), most patients with relapsing remitting MS (RRMS) convert to secondary progressive MS (SPMS), an MS-phenotype associated with a steady deterioration of functional ability independent from relapses and worsened prognosis. Due to the heterogeneity of this conversion, SPMS-diagnosis is often challenging and made retrospectively with a delay of several years. In this review, we first discuss advantages and limitations of screening tools for early SPMS-detection such as the SPMS nomogram, the MS prediction score, and the best SPMS definition approach. These screening tools might help to shorten the phase of diagnostic uncertainty. We then focus on the development of MSProDiscuss, a novel web-based tool that helps the treating neurologist to systematically assesses parameters highly relevant for SPMS-conversion during routine anamnesis. These parameters involve disease activity, symptoms, and impacts of the patient's overall symptoms. In a recent validation study, MSProDiscuss demonstrated high sensitivity, specificity, and interrater reliability. MSProDiscuss does not impose an additional time burden on the treating neurologist and its results are easy to interpret by a simple traffic light system. In first usability tests, it was therefore assessed as a helpful tool for the clinical routine. The early detection of clinically significant progression by diagnostic tools such as MSProDiscuss could open a time-window for therapeutic interventions.
Collapse
Affiliation(s)
- Hernan Inojosa
- Zentrum für klinische Neurowissenschaften, Klinik für Neurologie, Technische Universität Dresden/ Universitätsklinikum Dresden, Dresden, Deutschland
| | - Katja Akgün
- Zentrum für klinische Neurowissenschaften, Klinik für Neurologie, Technische Universität Dresden/ Universitätsklinikum Dresden, Dresden, Deutschland
| | - Katrin Haacke
- Zentrum für klinische Neurowissenschaften, Klinik für Neurologie, Technische Universität Dresden/ Universitätsklinikum Dresden, Dresden, Deutschland
| | - Tjalf Ziemssen
- Zentrum für klinische Neurowissenschaften, Klinik für Neurologie, Technische Universität Dresden/ Universitätsklinikum Dresden, Dresden, Deutschland
| |
Collapse
|
7
|
Alvarez E, Nair KV, Gorritz M, Bartolome L, Maloney H, Ding Y, Golan T, Wade RL, Kumar R, Su W, Shah R, Russo P. Identification and diagnosis of Secondary Progressive Multiple Sclerosis during the clinical encounter: Results from a physician survey. Mult Scler Relat Disord 2021; 50:102858. [PMID: 33799068 DOI: 10.1016/j.msard.2021.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is difficult to characterize the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS), due to symptomatic variability across patients. Diagnosis of SPMS is prolonged and often established retrospectively, as it is based on patient clinical history and symptoms. This cross-sectional study aimed to identify MS neurologist reported clinical indicators deemed important in diagnosing SPMS in clinical practice. METHODS A web-based quantitative survey was conducted among MS-treating neurologists across the United States in January 2019. The questionnaire comprised of 17 questions evaluating primary clinical indicators used by neurologists in assessing patient progression to SPMS. Treatment approach and factors influencing treatment decision-making following SPMS diagnosis were also analyzed in the survey. RESULTS Overall, 300 neurologists completed the survey; most of the respondents were general MS-treating neurologists (63%) and from private care setting (58%). The overall respondents as well as MS-focused neurologists ranked patient history (45% and 42%, respectively) and patients' neurological exam (39% and 44%, respectively) as -primary clinical indicators of SPMS diagnosis. 57% of neurologists always or mostly switched disease modifying therapies after progression to SPMS, and mostly considered 3-6 months' assessment interval to diagnose SPMS. CONCLUSION The survey indicated that neurologists are able to recognize signs of SPMS within six months of symptomatic assessment. The diagnosis is primarily based on patient history among MS-treating neurologists. Therefore, continued education to neurologists may facilitate early diagnosis and timely introduction of effective treatment to manage the progression of SPMS.
Collapse
Affiliation(s)
- E Alvarez
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - K V Nair
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - M Gorritz
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - L Bartolome
- Thomas Jefferson University, Philadelphia, PA, USA
| | - H Maloney
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - Y Ding
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - T Golan
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R L Wade
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R Kumar
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - W Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Shah
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - P Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| |
Collapse
|
8
|
Inojosa H, Rauser B, Ettle B, Ziemssen T. The transitional phase of multiple sclerosis: The concept of PANGAEA 2.0 evolution study. Mult Scler Relat Disord 2020; 46:102523. [PMID: 32977073 DOI: 10.1016/j.msard.2020.102523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Hernan Inojosa
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital Dresden, Fetscherstr. 74, 01307 Dresden, Germany..
| |
Collapse
|
9
|
Inojosa H, Ziemssen T. How to reduce the delay of diagnosing secondary progression in multiple sclerosis. Mult Scler 2020; 27:646-647. [PMID: 32697175 DOI: 10.1177/1352458520943799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hernan Inojosa
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| |
Collapse
|
10
|
Volkov A, Popova E. New tools for early detection of multiple sclerosis progression: MSProDiscuss questionnaire. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:43-47. [DOI: 10.17116/jnevro202012007243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|