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.

OBJECTIVE: The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. MATERIALS AND METHODS: We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. RESULTS: With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants' mental models of disease and for intuitive navigation in order to decrease cognitive load. DISCUSSION: Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. CONCLUSIONS: Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.

Fine-grained software configuration management offers substantial benefits for large-scale collaborative software development, enabling a variety of interesting and useful features including complexity management, support for aspect-oriented software development, and support for communication and coordination within software engineering teams, as described in [4]. However, fine granularity by itself is not sufficient to achieve these benefits. Most of the benefits of fine granularity result from the ability to combine fine-grained artifacts in various ways: supporting multiple overlapping organizations of program source by combining fine-grained artifacts into virtual source files (VSFs); supporting coordination by allowing developers to precisely mark the set of artifacts affected by a change; associating products from different phases of the development process; etc.In this paper, we describe how a general aggregation mechanism can be used to support the various functionality enabled by fine grained SCM. We present a set of requirements that an aggregation facility must provide in order to yield these benefits, and we provide a description of the implementation of such an aggregation system in our experimental SCM system.

We describe pHPF, an research prototype HPF compiler for the IBM SP series parallel machines. The compiler accepts as input Fortran 90 and Fortran 77 programs, augmented with HPF directives; sequential loops are automatically parallelized. The compiler supports symbolic analysis of expressions. This allows parameters such as the number of processors to be unknown at compile-time without significantly affecting performance. Communication schedules and computation guards are generated in a parameterized form at compile-time. Several novel optimizations and improved versions of well-known optimizations have been implemented in pHPF to exploit parallelism and reduce communication costs. These optimizations include elimination of redundant communication using data-availability analysis; using collective communication; new techniques for mapping scalar variables; coarse-grain wavefronting; and communication reduction in multi-dimensional shift communications. We present experimenta...