OrthoSphere

Assistive-only CDS: OrthoPath provides clinical decision support only. Clinicians retain full responsibility for all clinical decisions. This tool does not autonomously diagnose, prescribe, or order. Do not enter patient identifiers or any Protected Health Information (PHI) into this MVP.

About OrthoSphere

Last updated: 2026-04-08

Assistive-Only Disclaimer

OrthoSphere is an orthopaedic intelligence platform that includes assistive clinical decision support (OrthoPath), evidence retrieval and citation (OrthoRAG), OncoRegistry (orthopaedic oncology case workspace for Pro users: guided intake, documents, timeline, and MDT-oriented views), and—when your tenant enables them—OrthoPilot (operational cockpit and drafting), OrthoSearch (research-assist and literature workspace), and OrthoMonitor (monitoring and follow-up visibility for Pro cases). Only OrthoPath (through its CDS engine) emits clinical recommendation objects when you run modules or snapshots; those outputs require independent clinical review by a qualified clinician. OncoRegistry is built on the same Pro case and protocol infrastructure but is positioned as data capture and workflow assistance—it does not autonomously recommend treatment. The platform does not autonomously diagnose, prescribe, order tests, or guide discharge. The clinician retains full professional and legal responsibility for all clinical decisions.

Do not enter patient identifiers or any Protected Health Information (PHI) into this tool.

Authorship and Attribution

System Developer: Dr. Ehsan Pendar, MD
Role: Clinical Informatics Lead and System Architect
Affiliation: Independent research; developed as a medical-grade open-source orthopaedic intelligence platform reference implementation
LinkedIn: https://www.linkedin.com/in/orthopendar/
Contact: orthopendar@gmail.com info@pendarlink.com
GitHub: orthopendar/OrthoPath-sample — public sample and documentation (README, repository structure, one protocol sample).
Platform Version: 1.23.1
Initial Release: 2026-02-24

All clinical logic was authored, reviewed, and validated by Dr. Pendar. Evidence anchors for each module are drawn from published guidelines and peer-reviewed literature cited in the per-module evidence manifests. No rule fires without a traceable evidence source.

This system has not undergone regulatory clearance (e.g. FDA 510(k), CE marking). It is provided as an assistive reference tool only.

What OrthoSphere Is

OrthoSphere is the umbrella orthopaedic intelligence platform. It is not only CDS: it brings together deterministic CDS, evidence retrieval, OncoRegistry (oncology case workspace on Pro), and tenant-gated OrthoPilot, OrthoSearch, and OrthoMonitor where those features are enabled, each with strict authority boundaries.

| Service | Role | Authority boundary | |--------|------|--------------------| | OrthoPath | Deterministic orthopaedic clinical decision support (Core: single-encounter; Pro: cases, timeline). | Only component that may emit recommendation objects (via CDS when you evaluate). All outputs require independent clinical review. | | OncoRegistry | Orthopaedic oncology workspace on Pro: guided intake (History/Exam, Imaging, Pathology, Treatment, Follow-up), document upload with extraction review (accept/reject suggested fields), timeline and visits, decision snapshots, and MDT summary views. Shown as its own area in the app (e.g. OncoRegistry / oncology routes under a case). Requires OrthoPath Pro (and tenant access). | Data capture and workflow support—not a separate recommender. Treatment decisions remain with the clinician; any CDS runs use the same assistive-only rules as OrthoPath. | | OrthoRAG | Orthopaedic evidence retrieval and citation. Explain-only; answers and citations from the knowledge base. | Must not emit recommendations or use clinical “decide” language. | | OrthoPilot | Operational cockpit on Pro: dashboard, read-only oncology ops, tasks, draft centre, notifications, saved views on tasks and drafts; governance and agents (admin) as read-only visibility where present. Requires OrthoPath Pro and tenant `pilot_enabled`. | Operational and draft support only; does not change oncology workflow state in OncoRegistry or emit CDS recommendations. | | OrthoSearch | Literature surveillance and workspace: saved searches, collections, notes, case links where enabled. Requires tenant `orthosearch_enabled` (and related feature configuration). | Research-assist only; not a clinical recommendation engine. | | OrthoMonitor | Monitoring and follow-up visibility for Pro cases: dashboards, follow-up queue, per-case summaries, tasks, forms, saved views, export, admin analytics where configured. Requires OrthoPath Pro and tenant `monitor_enabled`. | Visibility and documentation only; not a second CDS lane, not outbound alerts or orders. |

Core = single-encounter OrthoPath (module → structured input → recommendation + evidence). Pro = OrthoPath cases and timeline, OncoRegistry (oncology workspace on that infrastructure), OrthoRAG (Evidence Copilot) when enabled, OrthoPilot, OrthoSearch, and OrthoMonitor when those tenant features are on, decision snapshots, and replay. Both tiers are delivered under OrthoSphere.

OrthoPath module list — “How to use this module”

On the OrthoPath page, each clinical module card may show an optional How to use this module box when the underlying protocol pack includes `user_instruction.md`. That file supplies three short, assistive lines—Goal, How to use, and Practical use—so you can see what the module is for, what to enter before you run it, and typical clinical settings. The box is orientation only: it does not replace the structured run form, evidence text, or independent clinical review. Packs add or refresh this content over time (including soft-tissue sarcoma pathways and other modules); see the Changelog for platform notes.

Intended Users and Setting

Intended users: Qualified orthopaedic surgeons, emergency physicians, anaesthesiologists, and other licensed clinicians.
Setting: Secondary or tertiary care, point-of-care use alongside standard clinical assessment.
Not for: Autonomous use by non-clinicians. Not a substitute for specialist consultation.

System Architecture

OrthoSphere is implemented as a monorepo with one deployable stack: API, CDS engine, Evidence service, and Web app. Core services:

API Gateway — Tenant-aware HTTP API (FastAPI): request validation, routing, run persistence, and protocol listing. No recommendation logic; forwards CDS requests to the engine. Exposes oncology/registry endpoints used by OncoRegistry (cases, documents, extraction, timeline) alongside existing Pro case APIs.
CDS Engine — Deterministic rule evaluator: loads YAML protocol packs, evaluates each rule’s `when` condition against request inputs, and is the sole service that constructs recommendation objects. Supports priority-ordered firing (P1–P6) and exclusivity-group merge for multi-hit strategy packs. Oncology case workflows use the `ortho_oncology_case_builder` pack where configured.
Evidence Service — Read-only retrieval and citation packaging; structurally prevented from emitting recommendations. Used for evidence display, rationale lookup, and (where configured) document extraction suggestions in OncoRegistry—clinicians accept or reject candidates; observations are created only on accept.
Web app — Serves the user interface; OrthoPilot, OrthoSearch, and OrthoMonitor (and related navigation) appear when the corresponding tenant feature flags are enabled.

Clinical rules are encoded in YAML protocol packs. Each rule’s `when` condition is expressed in CEL (Common Expression Language) or a CEL-compatible subset—non-Turing-complete, safe for embedding—and each pack ships with an evidence manifest linking every rule to its supporting literature.

Limitations

OncoRegistry: Structured orthopaedic oncology workspace only—no standalone treatment engine. Extraction suggestions may be wrong or incomplete; they require human review. Same PHI and assistive-only posture as the rest of OrthoSphere. Feature and route availability depend on Pro subscription and tenant configuration.
OrthoPilot: Operational visibility and drafting only; does not mutate OncoRegistry workflow state or replace clinical judgment. Availability depends on Pro and `pilot_enabled`.
OrthoSearch: Tenant-gated research workspace; not a recommender. Availability depends on `orthosearch_enabled` and configuration.
OrthoMonitor: Follow-up visibility and documentation only; optional descriptive concern flags are not treatment recommendations. Availability depends on Pro and `monitor_enabled`.
OrthoPath module scope: Multiple clinical modules are available, including: Ottawa Ankle & Knee Imaging Rules, Regional Anesthesia & Anticoagulation, Open Fracture Initial Management & Antibiotics, Pathologic Fracture Risk & Treatment (Mirels), Metastatic Bone Disease (MBD) Management — Pro (long bones + reassessment), ETC vs DCO — Physiology-Guided Fixation Timing (Core snapshot), Periprosthetic Joint Infection (PJI) — Criteria (Hip/Knee) (IDSA 2013, ICM 2018, EBJIS 2021), Ortho VTE Prophylaxis (post–major orthopaedic surgery: THA, TKA, hip fracture; P1–P6 safety overrides, evidence-based agent selection, discharge duration, assistive-only), and Adult Soft Tissue Sarcoma — Initial Workup, Referral, and Biopsy Triage (priority-ordered first_match pathway for suspected soft tissue sarcoma; extremity/body wall/head-neck and retroperitoneal branches as published in the pack). Module 5 (MBD Pro) is limited to femur and humerus; spine, pelvis, tibia, and other sites receive escalation/MDT referral only. Module 6 (ETC vs DCO) provides assistive fixation-timing support (P1 hard-stops, P3 missingness, P4 ETC permissible, P5 escalation) from a single-encounter physiology snapshot; it does not use timeline or trend data. ETC/DCO Conversion Timing (Pro) is a time-aware module using the same evidence base as the Core ETC vs DCO module; it uses lactate/pH (and optional base deficit, SBP, HR, temp, Hb, INR) over a 12h window for conversion criteria and is available in the Pro case workspace via Evaluate Now. PJI diagnostic criteria supports criteria-based assessment for suspected PJI (major/minor criteria, red flags); it does not replace clinical judgement.
Evidence-based rules: Rules are based on the evidence cited in each module's evidence manifest. They do not cover all clinical presentations. Humerus Mirels thresholds (e.g. ≥8 vs 7) are evidence-dependent and surfaced as assistive options; MDT discussion is encouraged.
Derived features (Module 5): Timeline-derived values (e.g. followup_overdue_flag, pain_trend_over_14d) are v0.1 approximations from structured events and fixed windows; they do not replace a scheduling engine or full clinical documentation.
No ML or adaptation: The system does not learn or adapt from clinical use (no machine-learning inference).
No EHR integration: The system does not have access to electronic health records (EHR) or real-time patient data. Do not enter PHI; all inputs are structured (no free-text clinical notes as engine input).
Assistive only: Outputs are suggestions for consideration. All outputs require independent clinical review in the context of the full clinical picture. The system does not order tests, prescribe, or diagnose.