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. 2022 Apr 13;29(5):928-936.
doi: 10.1093/jamia/ocac028.

GARDE: a standards-based clinical decision support platform for identifying population health management cohorts

Richard L Bradshaw  1   2 , Kensaku Kawamoto  1   2 , Kimberly A Kaphingst  3   4 , Wendy K Kohlmann  2   3   5 , Rachel Hess  2   5   6 , Michael C Flynn  2   6   7 , Claude J Nanjo  1   2 , Phillip B Warner  1   2 , Jianlin Shi  1 , Keaton Morgan  1   2   8 , Kadyn Kimball  3 , Pallavi Ranade-Kharkar  1   9 , Ophira Ginsburg  10 , Melody Goodman  11 , Rachelle Chambers  10 , Devin Mann  10 , Scott P Narus  1 , Javier Gonzalez  10 , Shane Loomis  10   12 , Priscilla Chan  10 , Rachel Monahan  10 , Emerson P Borsato  1 , David E Shields  1   2 , Douglas K Martin  1   2 , Cecilia M Kessler  2   4 , Guilherme Del Fiol  1
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GARDE: a standards-based clinical decision support platform for identifying population health management cohorts

Richard L Bradshaw et al. J Am Med Inform Assoc. .

Abstract

Population health management (PHM) is an important approach to promote wellness and deliver health care to targeted individuals who meet criteria for preventive measures or treatment. A critical component for any PHM program is a data analytics platform that can target those eligible individuals.

Objective: The aim of this study was to design and implement a scalable standards-based clinical decision support (CDS) approach to identify patient cohorts for PHM and maximize opportunities for multi-site dissemination.

Materials and methods: An architecture was established to support bidirectional data exchanges between heterogeneous electronic health record (EHR) data sources, PHM systems, and CDS components. HL7 Fast Healthcare Interoperability Resources and CDS Hooks were used to facilitate interoperability and dissemination. The approach was validated by deploying the platform at multiple sites to identify patients who meet the criteria for genetic evaluation of familial cancer.

Results: The Genetic Cancer Risk Detector (GARDE) platform was created and is comprised of four components: (1) an open-source CDS Hooks server for computing patient eligibility for PHM cohorts, (2) an open-source Population Coordinator that processes GARDE requests and communicates results to a PHM system, (3) an EHR Patient Data Repository, and (4) EHR PHM Tools to manage patients and perform outreach functions. Site-specific deployments were performed on onsite virtual machines and cloud-based Amazon Web Services.

Discussion: GARDE's component architecture establishes generalizable standards-based methods for computing PHM cohorts. Replicating deployments using one of the established deployment methods requires minimal local customization. Most of the deployment effort was related to obtaining site-specific information technology governance approvals.

Keywords: CDS Hooks; FHIR; Health Level Seven (D057208); clinical decision support system (D020000); population health management (D000076602).

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Figures

Figure 1.
Figure 1.
GARDE’s component architecture diagram. GARDE, Genetic Cancer Risk Detector.
Figure 2.
Figure 2.
Population Coordinator’s workflow to identify, extract, transform, and load patient data from a patient database into the FactDB. This is a detailed view of the process required to perform steps 1 and 2 from Figure 1.
Figure 3.
Figure 3.
Population Coordinator bulk CDS evaluation process; a detailed view of Figure 1 step 3. CDS: clinical decision support.
Figure 4.
Figure 4.
The Population Coordinator’s population export process writing to the EHR’s import services. HER: electronic health record.
Figure 5.
Figure 5.
Population health management application based on Epic’s Healthy Planet.
See this image and copyright information in PMC

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