Development of a clinical decision support system for living kidney donor assessment based on national guidelines

Background Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimisation of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines. Methods We developed a clinical decision support system (CDSS), based upon national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors. Results The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able to identify contraindications, additional investigations, special considerations and predicted operation side in our patient cohort. 17/45 patients went on to donate a kidney, of whom 7 had major contraindications defined in the national guidelines, many of which were not identified by the clinical team. Only 43% of additional investigations recommended by national guidelines were completed, with the most frequently missed investigations being oral glucose tolerance testing and routine cancer screening. Conclusions We have demonstrated the feasibility of turning a complex set of national guidelines into an easy-to-use machine-readable CDSS. Comparison with real-world decisions suggests that use of this CDSS may improve compliance with guidelines and informed consent tailored to individual patient risks. Corresponding Author, Mr Simon R Knight, Senior Clinical Lecturer and Honorary Consultant Transplant Surgeon, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Old Road, Oxford OX3 7LE. Tel: +44 1865 227 131, Mob: +44 7909 921 103. E-mail: simon.knight@nds.ox.ac.uk Authorship All authors made a significant contribution to the content of this manuscript, as per ICMJE recommendations. SRK conceived the study idea, participated in study design, provided clinical input to the decision support system (CDSS), coded the CDSS, entered and analysed patient data and wrote the manuscript. KNC participated in study design, coded the clinical decision support system and reviewed the manuscript. MS participated in study design, developed the openclinical.net platform, advised on the technical development of the clinical decision support system, provided the tools required for data analysis and reviewed the manuscript. NH provided clinical input to the content of the clinical decision support system and reviewed the manuscript JPH participated in study design, provided clinical input to the content of the clinical decision support system and reviewed the manuscript JF developed the openclinical.net concept, participated in study design, advised on the technical development of the clinical decision support system and reviewed the manuscript. Disclosures JF is a shareholder and Chief Scientific Officer of Deontics Ltd., a commercial company that makes use of the technologies described in this paper. He is also a cofounder of OpenClinical CIC. MS is a cofounder of both Deontics Ltd and OpenClinical CIC. KNC is a Medical AI advisor for OpenClinical CIC. SK, JH and NH have no conflicts of interest in relation to this work. Funding This work did not receive funding from any external sources. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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