OrthoPath

Assistive Clinical Decision Support
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.

Changelog

Last updated: 2026-03-01

v1.4.0 — 2026-03-01 (Admin dashboard and clinician feedback)

Platform

  • Admin dashboard — Overview, Modules (enable/disable global and per-tenant), Tenants, Audit, and Feedback tab. Sign-in at `/admin/login`; first-time setup uses the bootstrap flow for the initial admin user (see Hosting and deployment doc).
  • Clinician feedback — After a run, users can submit agreement (agree / partially agree / disagree), optional categories and comment. Feedback is stored and viewable in Admin → Feedback, with Module and Run ID so you can tell which protocol and which evaluation each row refers to. Confirmation also appears on the run page after submit, and via API `GET /feedback?run_id=...`.

---

v1.3.0 — 2026-02-28 (Module 6)

Clinical Modules

  • Module 06 — ortho_etc_vs_dco_fixation_timing v1.0.0 — Physiology-Guided Fixation Timing (ETC vs DCO). Snapshot-based assistive module; deterministic rules with P1 hard-stops (vasopressors, SBP <80, lactate ≥4, pH <7.20, BD ≥10, temp <35°C, INR ≥1.5, PRBC ≥10/MTP), P3 missingness gate, P4 ETC permissible, P5 escalation (borderline physiology, severe injury, time-band). Derived banding (Option A) via `derive.py` with 10 computed bands. 14 rules, 9 evidence entries (Vallier 2015, Ratto 2013, EAST 2001, Brohi 2014, Verma 2014, Brohi & Cohen 2013, Gupta & Farooque 2023, Peralta/Delphi 2024). Completeness sweeps (TRUE/FALSE/UNKNOWN) in `test_etc_vs_dco_completeness.py`. Web form (`EtcDcoForm.tsx`) integrated into run page.

---

v1.2.0 — 2026-02-28 (Module 5 + Platform)

Clinical Modules

  • Module 5 — ortho_mbd_management_pro (Pro) v0.1.0 — Metastatic Bone Disease Management — Pro (long bones + reassessment). Fifth production module. Supports structured triage and pathway selection for femur and humerus metastatic lesions. CEL conditions, atomic_merge evaluation, timeline-derived features (post-RT reassessment, postop follow-up). Evidence: ASTRO 2024, ESTRO 2022, MSTS/AAOS femur CPG, MSTS humerus CPG, Mirels 1989. Completeness sweeps (TRUE/FALSE + UNKNOWN) in `test_module05_mbd_completeness.py`. See pack RELEASE_NOTES and KNOWN_LIMITATIONS for scope and limitations.
  • Modules 01–05 — Ottawa Ankle & Knee, Regional Anesthesia & Anticoagulation, Open Fracture Initial Management & Antibiotics, Pathologic Fracture Risk (Mirels), ETC vs DCO Fixation Timing remain at prior versions.

Platform

  • CEL support — Protocol packs may use `condition_language: "cel"` for rule conditions. CEL expressions are compile-checked at publish time with denylist, length, node, and list-literal limits.
  • atomic_merge evaluation_strategy — Packs may use `evaluation_strategy: "atomic_merge"` for multi-action output with exclusivity groups and suppress_groups.
  • Timeline derived features — Run requests support `events[]` and `as_of` for deterministic derived values (e.g. `days_since_last_RT_to_site`, `pain_trend_over_14d`, `time_since_surgery_days`). Packs with derived_features require `as_of` in golden tests.

User Interface (2026-02-28)

  • Module card user instructions — Each module card on the Modules tab shows an optional “How to use this module” block (goal, how to use, practical use) when the pack includes `user_instruction.md`. All five production modules now provide this content.
  • Evidence links — Module card reference chips resolve DOI, PMID, and URL locators correctly; placeholders are excluded from the displayed evidence list.

---

Assistive-Only Disclaimer

OrthoPath is an assistive clinical decision support tool only. Changes listed here are technical changes to rule logic and system behaviour. They do not imply clinical validation.

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

v1.0.0 — 2026-02-24 (MVP Release)

System Engineering

  • Monorepo scaffold: `services/`, `packages/`, `apps/web/`, `infra/`, `docs/`.
  • Strict schema validation (`extra="forbid"`) on all data models.
  • Deterministic rules engine: grammar-based condition parser, first-match priority evaluation.
  • Database schema: `protocols`, `protocol_versions`, `active_protocol_versions`, `cds_runs`, `audit_events`.
  • API Gateway: tenant isolation via `X-Tenant-ID` header, persistence-failure-fatal mode.
  • Verification Gate CLI (`protocol_verify`): layout, schema, condition syntax, safety language, evidence integrity, checksum checks.
  • CI pipeline: migrations, protocol ingest, tests, `protocol_verify --all`, OpenAPI 3.1 assertion, ruff lint.
  • Docker Compose for local development.

Clinical Modules

  • Module 01 — Ottawa Ankle & Knee Imaging Rules v1.0.0 (see v1.1.0 for current version)

Evidence base: Stiell et al. (1993, 1995, 1996), Bachmann et al. (2003), ACR Appropriateness Criteria (2020). 15 rules, 14 evidence entries.

  • Module 02 — Regional Anesthesia & Anticoagulation v1.0.0 (see v1.1.0 for current version)

Evidence base: ASRA 5th edition, ESAIC/ESRA guidelines, platelet threshold studies. 30+ rules, P2 safety blocks, P3 missingness gates.

  • Module 03 — Open Fracture Initial Management & Antibiotics v1.0.0 (see v1.1.0 for current version)

Evidence base: EAST guidelines, BOAST/BSSH, antibiotic RCTs, ACIP tetanus guidance. 14 rules, P1 life-safety escalation.

  • Module 04 — Pathologic Fracture Risk & Treatment (Mirels) v1.0.0 (see v1.1.0 for current version)

Evidence base: Mirels (1989) scoring system; Damron et al., Van der Linden et al. (2003); ASTRO palliative RT guideline (Lutz et al., 2017); operative and embolization literature. Risk-tier rules (low / intermediate / high) for observation, radiotherapy, or prophylactic fixation; protocol_suggestion and insufficient_data; optional Mirels score derivation from site/pain/lesion type/size.

User Interface

  • Module listing page with active protocol versions.
  • Structured input forms for all four production modules.
  • Copy-to-clipboard note export for all four modules.
  • About / Trust Dossier with sidebar navigation (this page).
  • Modules catalogue with evidence anchors and version badges.

v1.1.0 — 2026-02-27 (All modules v1.1.0)

Clinical Modules (all at v1.1.0)

  • Module 01 — Ottawa Ankle & Knee Imaging Rules v1.1.0

Strategy A: `action_key`, `group`, `exclusivity_group`, `rank` on all rules. Missingness gates promoted from P6 to P3 (R-007 through R-010b: weight-bearing, ankle/midfoot/knee tenderness, age_55_or_older). Resolves audit finding AUD-001. Documentation actions (P5) for “why” (e.g. acute window, weight-bearing). 18 rules, 14 evidence entries.

  • Module 02 — Regional Anesthesia & Anticoagulation v1.1.0

Version alignment; same evidence base and rule set (ASRA 5th, ESAIC/ESRA, platelet thresholds). P2 safety blocks, P3 missingness gates.

  • Module 03 — Open Fracture Initial Management & Antibiotics v1.1.0

Version alignment; same evidence base and rule set (EAST, BOAST/BSSH, antibiotic/tetanus guidance). P1 life-safety escalation.

  • Module 04 — Pathologic Fracture Risk & Treatment (Mirels) v1.1.0

Version alignment. Protocol pack `ortho_pathologic_fracture_risk_mirels`: risk-tier rules (pathological_fracture, lesion_location, prognosis_tier, surgical_candidate, Mirels score). Optional derivation of Mirels total from site/pain/lesion type/size. Evidence: Mirels 1989, Damron/Van der Linden 2003, ASTRO 2017 (see Evidence page).

User Interface

  • Run page form picker and copy-note export for all four production modules. Modules catalogue lists four modules with version badges.

System / Operations

  • GitHub: private backup repo (`orthopendar/OrthoPath`), public sample repo (`orthopendar/OrthoPath-sample`) with README, repository structure overview, and one sanitized protocol sample. Documented in `docs/GITHUB_BACKUP_AND_PUBLIC_SAMPLE.md`.

Known Limitations (v1.1.0)

  • Module 02 LMWH drug token has no dedicated clinical rules (audit finding AUD-002).
  • Module 03 allergy branching not yet implemented (audit finding AUD-006).
  • No rate limiting, authentication, or RBAC implemented in this release.