Identifying Provider and Patient Barriers to the Implementation of (MeTree) Family Health History Clinical Decision Support (FHH CDS) Tools

Objective: The purpose of this study was to determine healthcare provider and patient barriers in the implementation of a FHH CDS tool. Background: The University of North Texas Health Science Center (UNTHSC) in collaboration with Duke University and other sites around the country is currently conducting an implementation-effectiveness study to investigate MeTree implementation. MeTree, a Family Health History Clinical Decision Support (FHH CDS) tool is a patient facing tool that provides disease risk-stratification to both patients and providers. In previous studies, several perceived barriers for the use of this type of tool were identified including limited time during a patient visit and a lack of patient knowledge to provide family health history. This is especially true in regard to primary care clinics that cater to underserved populations. Methods: Family Medicine providers from three primary care clinics were identified and recruited. Eligible patients of consented providers were invited to participate in the study via recruitment letters. Registration information was obtained from interested patients, and unique study IDs were assigned by study coordinators at UNT Health Science Center. Registered patients received an email link to e-consent and complete the family health history online using the MeTree software. A printed copy of the risk report generated on completion of MeTree was delivered to the primary care provider to be reviewed at their next clinical appointment. Results: To date, patients of two Family Medicine providers were invited to participate in the study. Of the 2711 who were invited, 92 patients registered (response rate 3.39%) and 11 patients completed MeTree (completion rate 11.9%). Qualitative information collected through in-person discussions with providers indicated a preference of integration of the risk stratification report into the electronic medical record (EMR) system versus a printed copy of the report. Patient barriers included lack of access to a computer and internet. Conclusion: Provider engagement in implementation of new clinical decision support tools is imperative for identifying barriers as well as providing potential solutions for these barriers.