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

> **NIH NIH R43** · ELIMU INFORMATICS, INC. · 2024 · $353,403

## Abstract

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...

## Key facts

- **NIH application ID:** 10919374
- **Project number:** 1R43HL174218-01
- **Recipient organization:** ELIMU INFORMATICS, INC.
- **Principal Investigator:** Aziz A Boxwala
- **Activity code:** R43 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $353,403
- **Award type:** 1
- **Project period:** 2024-09-20 → 2026-03-19

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10919374

## Citation

> US National Institutes of Health, RePORTER application 10919374, TIBSA: A tailored interoperable guideline-based clinical decision-support system for asthma (1R43HL174218-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10919374. Licensed CC0.

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