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 journalArticlepeer-review


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 languageEnglish (US)
Pages (from-to)928-936
Number of pages9
JournalJournal of the American Medical Informatics Association
Issue number5
StatePublished - May 1 2022


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

ASJC Scopus subject areas

  • Health Informatics


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