HIT Asthma: A Tale of Woe and Enlightenment

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]

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]

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]

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]

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]

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

HIT Asthma: A Tale of Woe and Enlightenment

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HIT Asthma: A Tale of Woe and Enlightenment