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

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 ChanRachel Monahan, Emerson P. Borsato, David E. Shields, Douglas K. Martin, Cecilia M. Kessler, Guilherme Del Fiol

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

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.

Original language	English
Pages (from-to)	928-936
Number of pages	9
Journal	Journal of the American Medical Informatics Association : JAMIA
Volume	29
Issue number	5
DOIs	https://doi.org/10.1093/jamia/ocac028
State	Published - 1 May 2022
Externally published	Yes

Keywords

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

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10.1093/jamia/ocac028

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Bradshaw, R. L., Kawamoto, K., Kaphingst, K. A., Kohlmann, W. K., Hess, R., Flynn, M. C., Nanjo, C. J., Warner, P. B., Shi, J., Morgan, K., Kimball, K., Ranade-Kharkar, P., Ginsburg, O., Goodman, M., Chambers, R., Mann, D., Narus, S. P., Gonzalez, J., Loomis, S., ... Del Fiol, G. (2022). GARDE: A standards-based clinical decision support platform for identifying population health management cohorts. Journal of the American Medical Informatics Association : JAMIA, 29(5), 928-936. https://doi.org/10.1093/jamia/ocac028

@article{7831a5ac7be44b93a5710288e77ebb28,

title = "GARDE: A standards-based clinical decision support platform for identifying population health management cohorts",

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)",

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

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: [email protected].",

year = "2022",

month = may,

day = "1",

doi = "10.1093/jamia/ocac028",

language = "English",

volume = "29",

pages = "928--936",

journal = "Journal of the American Medical Informatics Association : JAMIA",

issn = "1067-5027",

publisher = "Oxford University Press",

number = "5",

}

Bradshaw, RL, Kawamoto, K, Kaphingst, KA, Kohlmann, WK, Hess, R, Flynn, MC, Nanjo, CJ, Warner, PB, Shi, J, Morgan, K, Kimball, K, Ranade-Kharkar, P, Ginsburg, O, Goodman, M, Chambers, R, Mann, D, Narus, SP, Gonzalez, J, Loomis, S, Chan, P, Monahan, R, Borsato, EP, Shields, DE, Martin, DK, Kessler, CM & Del Fiol, G 2022, 'GARDE: A standards-based clinical decision support platform for identifying population health management cohorts', Journal of the American Medical Informatics Association : JAMIA, vol. 29, no. 5, pp. 928-936. https://doi.org/10.1093/jamia/ocac028

TY - JOUR

T1 - GARDE

T2 - A standards-based clinical decision support platform for identifying population health management cohorts

AU - Bradshaw, Richard L.

AU - Kawamoto, Kensaku

AU - Kaphingst, Kimberly A.

AU - Kohlmann, Wendy K.

AU - Hess, Rachel

AU - Flynn, Michael C.

AU - Nanjo, Claude J.

AU - Warner, Phillip B.

AU - Shi, Jianlin

AU - Morgan, Keaton

AU - Kimball, Kadyn

AU - Ranade-Kharkar, Pallavi

AU - Ginsburg, Ophira

AU - Goodman, Melody

AU - Chambers, Rachelle

AU - Mann, Devin

AU - Narus, Scott P.

AU - Gonzalez, Javier

AU - Loomis, Shane

AU - Chan, Priscilla

AU - Monahan, Rachel

AU - Borsato, Emerson P.

AU - Shields, David E.

AU - Martin, Douglas K.

AU - Kessler, Cecilia M.

AU - Del Fiol, Guilherme

N1 - Publisher Copyright: © 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: [email protected].

PY - 2022/5/1

Y1 - 2022/5/1

N2 - 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.

AB - 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.

KW - CDS Hooks

KW - FHIR

KW - Health Level Seven (D057208)

KW - clinical decision support system (D020000)

KW - population health management (D000076602)

UR - http://www.scopus.com/inward/record.url?scp=85128488887&partnerID=8YFLogxK

U2 - 10.1093/jamia/ocac028

DO - 10.1093/jamia/ocac028

M3 - Article

C2 - 35224632

AN - SCOPUS:85128488887

SN - 1067-5027

VL - 29

SP - 928

EP - 936

JO - Journal of the American Medical Informatics Association : JAMIA

JF - Journal of the American Medical Informatics Association : JAMIA

IS - 5

ER -

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

Abstract

Keywords

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