TIBSA: A tailored interoperable guideline-based clinical decision-support system for asthma

Project Summary Asthma is a significant public health concern affecting the quality of life of over 8% of the US population and causing more than a million emergency department visits every year. The standard of care for asthma changed dramatically with the publication of the 2020 NHLBI Asthma Management Guidelines: Focused Updates. The guidelines contained paradigm-shifting recommendations for treatment and monitoring. Of 19 recommendations, 16 were considered ‘conditional’, meaning that shared decision making (SDM) between the provider and patient was advised prior to choosing an option. Unfortunately, many of the recommendations have yet to be incorporated into the care of asthma patients: less than 50% of the recommendations had been incorporated into clinical practice and over a third of surveyed of physicians had no awareness of the new asthma recommendations. Such delays in guideline implementation have been associated with adverse health outcomes, increased costs, and worsening health disparities. We previously developed an intervention that can collect patient-entered data pertinent to SDM in asthma which is then utilized by providers during office visits. This intervention was well received by both patients and physicians, improving patient satisfaction and quality of SDM during the clinical encounter. There is now an urgent need to develop a clinical decision-support (CDS) application that incorporates the key recommendations from the Asthma Guidelines Update, patient-specific clinical information, SDM-relevant patient values and preferences, and the social determinants of the health (SDOH) of the patient. To make the application widely usable, the CDS application must be based on EHR interoperability standards that will make it easier to implement CDS at multiple sites. The long-term objectives of this project are to design, develop, rigorously evaluate, and disseminate TIBSA (tailored interoperable guideline-based clinical decision-support system for asthma). TIBSA will be designed to address common deficiencies in CDS such as usability and poor applicability to the patient. In this Phase I project we will focus on the treatment of asthma in adults with these objectives: 1. Identify the requirements and create the design of TIBSA collaboratively with patients, clinicians and informaticians. The design will be validated and refined in two focus group panels representing clinical users and patients with asthma. 2. Create a minimally viable product version of TIBSA. We will create the application with Sapphire, our rapid application development platform that has capabilities for clinician SMART on FHIR apps, workflow automation, decision-support logic evaluation, and flexible engagement with patients. The application will be evaluated with clinicians and patients in a usability studyl. We will obtain data from these subjects on feasibility, acceptability, and appropriateness of TIBSA. In Phase II of this project, we will further refine TIBSA, and test its integration with EHRs. We will deploy the application within at least two clinical sites and perform an evaluation of its acceptance and impact on clinician adherence to guidelines and patient satisfaction with treatment decisions.