Table 1 Barriers and facilitators to genomic testing implementation based on the CFIR framework inner setting constructs25
From: Qualitative study of system-level factors related to genomic implementation
CFIR framework: inner setting | ||
|---|---|---|
Applied construct | CFIR construct | Implementation application for research and clinical practice |
Barriers | ||
Incorporating genomics into electronic health records | Available Resources Stakeholder Engagement | • Lack of integration of decision support tools or testing results into electronic health records (EHR) • Current technology lacks appropriate computer logic for interpretation of genomic testing • Required IT collaboration for integration |
Reluctance to do genomics research | Culture Stakeholder Engagement | • Unease in accepting research without guarantee for improvement of patient health • Physician preference for known technology or procedures • Not all patients have comfort with genomic testing and limited patient buy-in |
Reimbursement | Infrastructure Changes | • Lack of funding for testing outside of research setting • Limited avenues for reimbursement for genomic testing in current health-care climate |
Facilitators | ||
Investigator and clinician communication | Networks & Communication Goals & Feedback | • Use of various platforms to share information about research projects: meetings, conferences, and grand rounds • Conference calls for all sites to introduce study, standardize procedures, and problem solve • Solicitation of feedback in detailing best practices for project implementation • Communication between clinicians about genomic testing and integrating genomic testing into practice |
Clinician champions as facilitators of genomic implementation | Stakeholder Engagement Leadership Engagement | • Establishment of physician leadership on a departmental level to assist with recruitment and buy-in • Use of early adopters to encourage participation from other clinicians • Recommendation to use testing and support tools between clinicians |
Leadership engagement | Leadership Engagement Available Resources | • Hospital administration or leadership support for research and required resources • Access to funding or administrative assets for research required changes to technology, labs, or clinic settings • Buy-in from C-level to increase project priority and reduce administrative concerns |
