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HIT Asthma: A Tale of Woe and Enlightenment

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Yiscah Bracha

Describes challenges encountered in converting clinical practice guidelines for asthma into electronic decision support software. Presented at annual mtg of AHRQ, Sept 08.

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AHRQ Annual Meeting 09SEP08 HIT Asthma a tale of woe and enlightenment Yiscah Bracha, M.S. [email_address]
Project Objective: ,[object Object],[object Object],[object Object],[object Object]
What we knew: ,[object Object],[object Object],[object Object]
What we wanted to propose: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],One small problem…
What we actually proposed: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Expected challenges ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3 months after project inception: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Famous last words:
Oops: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The struggle: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Some concerns: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More concerns: ,[object Object],[object Object],[object Object]
And more struggles: ,[object Object],[object Object]
The tale of woe… ,[object Object],[object Object],[object Object],[object Object],[object Object]
The tale of enlightenment: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* Bob Mayes, our AHRQ Task Order Officer
From: Expert Panel Guidelines To: Electronic Clinical Decision Support:
What are the Primary Challenges? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Primary Challenges ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The human mind: ,[object Object],[object Object],[object Object],[object Object]
The software mind…
More peaks into the software mind…
Human vs software “minds”: No tolerance for ambiguity Can tolerate ambiguity Precise meaning of words required Approximate meanings of words OK Counterfactuals not possible Counterfactuals entertained Linear, step-by-step “ Gestalt” Series of nested and explicit if-then statements Fast, unarticulated thought processes Software Humans
The negotiation challenge: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Software Development Challenges ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
From this….
 
… to this
 
Combinatorial volume ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Challenges posed by volume: ,[object Object],[object Object],[object Object],[object Object]
Software Development Challenges ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Different words for same ideas: I thought my child would die ED visit Exacerbation My top number on the meter What you can and should be able to blow FEV 1 actual vs. predicted Purple inhaler Daily controller Long-acting beta agonist Ordinary: Clinical: Academic:
Because of differing vocabulary: ,[object Object],[object Object],[object Object],[object Object]
Because of differing vocabulary: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The challenge posed by vocabulary: ,[object Object],[object Object],[object Object]
Some preliminary conclusions
Policy Qs the process reveals: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Addl policy Qs the process reveals: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sustainability questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Our work continues: ,[object Object],[object Object],[object Object],[object Object],[object Object]
And: ,[object Object]
Improving Asthma Care in an Integrated Safety Net through a Commercially Available Electronic Medical Record ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
… and now, Bob Mayes our Task Order Officer

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HIT Asthma: A Tale of Woe and Enlightenment

  • 1. AHRQ Annual Meeting 09SEP08 HIT Asthma a tale of woe and enlightenment Yiscah Bracha, M.S. [email_address]
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  • 17. From: Expert Panel Guidelines To: Electronic Clinical Decision Support:
  • 18.
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  • 22. More peaks into the software mind…
  • 23. Human vs software “minds”: No tolerance for ambiguity Can tolerate ambiguity Precise meaning of words required Approximate meanings of words OK Counterfactuals not possible Counterfactuals entertained Linear, step-by-step “ Gestalt” Series of nested and explicit if-then statements Fast, unarticulated thought processes Software Humans
  • 24.
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  • 27.  
  • 28. … to this
  • 29.  
  • 30.
  • 31.
  • 32.
  • 33. Different words for same ideas: I thought my child would die ED visit Exacerbation My top number on the meter What you can and should be able to blow FEV 1 actual vs. predicted Purple inhaler Daily controller Long-acting beta agonist Ordinary: Clinical: Academic:
  • 34.
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  • 40.
  • 41.
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  • 43.
  • 44. … and now, Bob Mayes our Task Order Officer