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

Richard L Bradshaw; Kensaku Kawamoto; Kimberly A Kaphingst; Wendy K Kohlmann; Rachel Hess; Michael C Flynn; Claude J Nanjo; Phillip B Warner; Jianlin Shi; Keaton Morgan; Kadyn Kimball; Pallavi Ranade-Kharkar; Ophira Ginsburg; Melody Goodman; Rachelle Chambers; Devin Mann; Scott P Narus; Javier Gonzalez; Shane Loomis; Priscilla Chan; Rachel Monahan; Emerson P Borsato; David E Shields; Douglas K Martin; Cecilia M Kessler; Guilherme Del Fiol

doi:10.1093/jamia/ocac028

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

J Am Med Inform Assoc. 2022 Apr 13;29(5):928-936. doi: 10.1093/jamia/ocac028.

Authors

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 Shi¹, Keaton Morgan^{1

2

8}, Kadyn Kimball³, Pallavi Ranade-Kharkar^{1

9}, Ophira Ginsburg¹⁰, Melody Goodman¹¹, Rachelle Chambers¹⁰, Devin Mann¹⁰, Scott P Narus¹, Javier Gonzalez¹⁰, Shane Loomis^{10

12}, Priscilla Chan¹⁰, Rachel Monahan¹⁰, Emerson P Borsato¹, David E Shields^{1

2}, Douglas K Martin^{1

2}, Cecilia M Kessler^{2

4}, Guilherme Del Fiol¹

Affiliations

¹ Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
² University of Utah Health, Salt Lake City, Utah, USA.
³ Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
⁴ Department of Communication, University of Utah, Salt Lake City, Utah, USA.
⁵ Departments of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.
⁶ Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
⁷ Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.
⁸ Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
⁹ Intermountain Healthcare, Salt Lake City, Utah, USA.
¹⁰ New York University Langone Health, New York City, New York, USA.
¹¹ School of Global and Public Health, New York University, New York City, New York, USA.
¹² Epic Systems Corporation, Madison, Wisconsin, USA.

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).

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Decision Support Systems, Clinical*
Delivery of Health Care
Electronic Health Records
Humans
Information Storage and Retrieval
Population Health Management*

Abstract

Publication types

MeSH terms

Grants and funding