02/03/2022 Compiled by Valmeek Kudesia

General Context

Characteristics

• Allows a person, who is not an expert in a subject matter to accomplish meaningful goals in the same subject matter AS IF that person was an expert in the subject matter

  • Real-world feasibility usually requires focus on specific subject matter and specific meaningful goals in the subject matter.

    • "Specific" = most, many, some, or few of the meaningful goals in the subject matter area

    • "Specific" = not ANY arbitrary goal in subject matter area

  • Focuses upon growth or action with direct instead of indirect relationship to end-to-end real-world outcome

  • Does not focus upon

    • Simplified or artificial distortions of meaningful goals within a subject matter that an expert would not consider authentic

    • Specific steps that an expert performs to achieve the meaningful goals (usually achieves the meaningful goals via a method derived from method of a subject matter expert.

  • Real-world relevance of each meaningful goal in a subject matter area may vary widely i.e. 80% of real-world end-to-end outcomes is concentrated on 20% of meaningful goals within a subject matter area.

  • Usually, support of >50% of end-to-end real-world outcomes in a consistent and repeatable fashion yields a solution for general availability

• Uses abstractions to boosts performance of novice e.g.

  • Expands the awareness of important information available to novice

  • Expands the range of actions available to novice

  • Expands the upper bound of novice capability

  • Enables of related additional capability by a novice

• If abstraction is a virtual system, this usually follows a known progression pattern e.g.

  • have visibility more like an expert

  • have the capability more like an expert

Illustrative Examples

• • An navigation app on a consumer-grade mobile device that allows a person to

    • arrive at a specific restaurant (must be documented prior, not any arbitrary restaurant)

    • in a specific unfamiliar city (must be mapped prior, not any arbitrary city)

    • AS IF that person had detailed knowledge of streets and traffic patterns in that city

    • SO THAT a person who lives in that city would find the route plausible

  • Specialized consumer-grade kitchen appliances e.g. bread maker that allow a person to

    • produce a specific range (must be documented prior e.g. whole-wheat bread, sourdough bread, not any arbitrary type of bread)

    • of specific foods (must be defined prior e.g. only breads, not any arbitrary type of bread or pastas, or cakes)

    • AS IF that person had detailed culinary knowledge of those types of foods

    • SO THAT an expert in the type of food (e.g. expert baker) would find the food acceptable

Illustrative Counter-Examples

• • • A solution that only made the car's steering wheel easier to turn; this would reduce the effort needed to steer the car easier but unlikely to substantially improve a person's likelihood of real-world arrival at the restaurant in an unfamiliar city

    • A solution that focused on identifying the best bread-baking pan out of a wide selection of pans; this would address a challenge likely only faced by expert bakers who have a wide selection of different baking pans.

Real-World Impact

Based on Gulf between desire and acceptability, real-world behavior may self-limit to favor the generally available solution given constraints (e.g. convenience, reliability, price) and expand the real-world impact of a given solution e.g.

• • Patrons start to favor dining at specific restaurants that are find-able via a navigation app

  • Individuals start to favor specific types of bread with more convenient availability

Clinical Context

Characteristics

Allows a person with a given level of training, experience, or license to

• Consistently achieve a specific range of outcomes in a specific clinical area

• AS IF that person had a higher level of training, experience, or license

• SO THAT another person with higher level of training or experience would find outcome acceptable

Illustrative Examples

• • A calculator that performs

    • dose adjustment of warfarin (specific medication)

    • based on specific patient characteristics and is available for any prescribing clinician

    • AS IF that clinician had specific training at an anticoagulation clinic

  • A system that allows a

    • specific clinician to quickly order

    • specific pharmacy to quickly receive and dispense urgently needed medications

    • AS IF the clinician and pharmacy had many years of working as a team with well-established communication practices and well-known areas of potential confusion

  • A system that allows a

    • specific care manager to know when their assigned patients

    • visit specific emergency departments or are admitted to specific hospitals

    • AS IF the care manager had many years of professional relationship with the staff at those facilities

Illustrative Unsuccessful Counter-Examples

• • A solution that only made it easier to enter numbers into a general purpose calculator

    • Lowers effort needed to type numbers

    • Unlikely to substantially increase likelihood of real-world correct dose adjustment of warfarin for patient characteristics

  • A solution that only increased the speed of which the clinician wrote by hand the prescription

    • Lowers the effort needed to hand-write a medical prescription

    • Unlikely to substantially reduce the time needed for a pharmacy end-to-end receive and dispense a medication.

  • A solution that only automated the dialing of a desk phone to call the care manager for a verbal conversation between on-site staff and care manager

    • Marginally reduces the barrier to alert a care manager

    • Likely to increase barrier for on-site clinicians to place a phone call to other important locations e.g. on-site laboratory

Real-World Impact

Real-world clinical behavior may self-limit to the generally available and more reliable solution e.g. prescribing clinicians may favor specific pharmacies that reliably receive and dispense medications

References

• Notes from Andy Matuschak