(T-117) A High-Dose Methotrexate Dashboard: Integrating MTXPK.org into the Electronic Health Record to Facilitate Model-Informed Care for Pediatric Patients with Malignant Conditions

Nieko Punt, N/A – Consultant, Medimatics; Chris Jenkinson, N/A – Lead Developer, Cincinnati Children's Hospital Medical Center; Bill Vidonish, N/A – Lead Developer, Cincinnati Children's Hospital Medical Center; Jennifer Young, PharmD – Pharmacist, Cincinnati Children's Hospital Medical Center; Maureen O'Brian, MD, MS – Professor, University of Colorado Anschutz Medical Campus; Laura Ramsey, PhD – Section Head for Individualized Therapeutics, Children's Mercy Kansas CIty

The MTXPK.org webtool is a freely available clinical decision support tool designed to facilitate model-informed supportive care and optimize glucarpidase use in pediatric and adult patients receiving high-dose methotrexate (MTX) for the treatment of malignant conditions. This webtool has been adopted into routine clinical care and provides global access to more than 1,000 unique users per month. To use the MTXPK.org webtool, clients must manually enter all relevant patient data, which could cause entry errors. Recent advances allow users to upload these data directly into the webtool; however, data files must be appropriately formatted and entry errors are still possible. Clinicians have requested integration with the electronic health record (EHR) to allow for automated entry of patient data. The objective of this project was to integrate the MTXPK.org webtool with the EHR at a pediatric research hospital. The MTXPK.org webtool references a three-compartment population pharmacokinetic model1 that includes body surface area, serum creatinine, albumin, presence of Down syndrome, and infusion duration as clinical variables associated with MTX clearance, and pleural effusion on volume of distribution. The backend of the MTXPK.org webtool applies Bayesian estimation using this nonlinear model and real-time patient data provided by the user to generate an individualized concentration-time (CT) profile displaying interactive visual and numerical information that guides decision-making. A human factors study ensured that user feedback was incorporated into the dashboard's development. The pipeline was reassembled to operate within the confines of the Epic EHR and tested for accuracy. The MTXPK.org dashboard has successfully launched at the pediatric research hospital. Upon initialization of the dashboard from within the EHR, it queries the patient’s records to capture relevant demographics, dosing information, and labs, then groups these data for each MTX administration. The user can access a dropdown list that displays all available MTX administrations detected by the dashboard. Users can select an administration from this dropdown, which prompts the display of the individualized Bayesian estimated CT profile for the individual. The CT profile is overlaid with the institutional leucovorin nomogram and provides the user with interactive visual and numerical feedback that aids in model-informed decision-making. The MTXPK.org EHR-integrated dashboard is designed to improve the user experience by automating the entry of patient data, reducing the chance for entry errors and the time it takes to use the tool. This integration provides the user with quick, seamless access to individualized CT profiles with interactive visual and numerical feedback that facilitate model-informed supportive care and optimize glucarpidase use in pediatric patients receiving high-dose methotrexate for the treatment of malignant conditions.

Citations: 1 Taylor ZL, Miller TP, Poweleit EA, et al. Clinical covariates that improve the description of high dose methotrexate pharmacokinetics in a diverse population to inform MTXPK.org. Clin Transl Sci. 2023; 16: 2130-2143. doi:10.1111/cts.13600