Veterans Health Administration (VHA) Clinical Decision Support (CDS) Knowledge Artifact (KNART) Program

Executive Summary

Cognitive Medical Systems led clinical and technical content delivery teams in a $12M VHA program to build computable guidelines for the VA knowledge-based systems CDS initiative. This effort was awarded a 2018 Federal Health IT Innovation Award.


VHA clinical systems and practices are varied across the massive VHA healthcare network. Cognitive developed a process to create standardized treatment pathways from harmonized VHA practices, evidence-based guidelines, and CDS rules. This body of clinical knowledge was transformed by Cognitive Medical Systems into standardized computable representations (HL7 CDS KNART) to aid VHA efforts in advancing CDS capabilities and system modernization.

How We Helped

Under this work, we developed intellectual property and led a “knowledge factory” workflow that successfully leveraged a distributed team of medical doctors, nurses, informaticists, data scientists, and software engineers to perform large-scale production and validation of structured clinical content for CDS and electronic medical record (EMR) integration. This work included the development of over 100 guidelines across 10 clinical domain areas made available in the HL7 CDS KNART Specification (HL7, 2015), a computable CDS standard. Modeling and governance work performed during this contract paved the way for an informed discussion and the design of cost models and platforms needed to leverage this rich clinical content and knowledge.

Project Outcome

Our team and our clients felt committed to providing open-source output from this project to allow collaboration with other healthcare systems, with the goal of increasing standardization and reducing duplicative work efforts across the industry. The VHA team has now partnered with the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS) to advance the KNART process to the next level and promote broad, general use.

The Patient-Centered CDS Learning Network and AHRQ are advancing the work of the KNART project to include engaging the stakeholder community, creating a prototype infrastructure for sharing and developing CDS systems, and advancing CDS through demonstration and dissemination research.