Context: Shared decision making (SDM) is a patient-centered concept difficult to implement in primary care with time being a critical issue. Coach McLungsSM offers a solution. The interactive digital coaching experience engages patients, caregivers, and providers in a tailored conversation about asthma and promotes SDM in creating a plan of care in 3 simple steps:1) Before seeing the provider, the patient and parent work with Coach McLungsSM; the app collects patient-reported information in an engaging way and provides standardized and tailored education on asthma, triggers, and treatments. 2) The tool gathers information about the patient’s goals, adherence, and symptoms, generating clinical decision support summary pages to guide the asthma visit. 3) The patient, caregiver, and provider then meet to create a personalized treatment plan at the point of care.
The first version of Coach McLungsSM had limitations such as ages 7-17, English only, no follow-up experience, usability issues such as difficult navigation, inability to replay, inputted information not stored, and not integrated into normal provider workflow. These issues required our team to facilitate an update and rebuild the application, which has led to many challenges and a few successes. Objective: To describe the successes and challenges in application redevelopment
Study Design: Quality improvement Setting: Large healthcare system.Main Outcomes: Redevelopment was challenging due to the intricacy of the rich multimedia patient interface and complexity of built-in logic pathways. Challenges included syncing animation and voice over, rebuilding complex decision support pathways, and creating new improvements such as follow-up and educational modules. A large healthcare system has many layers of oversight and processes to navigate innovation, particularly around security. Coordination between the research team, information technology, governance, and the software developer was time intensive and required flexibility in adapting the timeline. Challenges included shifting internal resources to implement a new electronic health record and rapidly evolving cybersecurity requirements. Shifting priorities during the pandemic offered more time to focus attention on perfecting the usability experience and integrate revised medication options mirroring the 2020 focused updates to the NIH asthma guidelines. Conclusions: Redevelopment of Coach McLungsSM V2.0 has been two steps forward and one step back.