An exploratory mixed-methods study using the ELICIT framework to identify stakeholder-informed implementation...

GARDE is an open-source software platform that supports population health management interventions including hereditary cancer cohort identification, patient engagement, education, and access to genetic testing services. To facilitate GARDE implementation, we applied the Evaluation in Life Cycle of Information Technology framework to 1) identify barriers and facilitators to the implementation of GARDE at five healthcare systems in differing implementation phases, 2) develop implementation strategies to address barriers, and 3) prioritize implementation strategies for implementation toolkit development based on partner-rated feasibility and importance.

We facilitated focus group discussions and individual in-depth interviews (n = 17) at five healthcare systems that have implemented or are implementing GARDE to identify contextual determinants of implementation and strategies to address implementation barriers. We relied on the Evaluation in Life Cycle of Information Technology framework to develop the interview guide and analyze data using rapid qualitative techniques. Our team identified implementation strategies in response to reported barriers. GARDE implementers were surveyed to assess the feasibility and importance of implementation strategies.

Participants at all healthcare systems identified multiple GARDE implementation barriers and facilitators, largely focusing on information technology needs to effectively implement an electronic health record-integrated innovation. Eight implementation strategies were identified as both important and feasible to address identified barriers.

Population health management innovations are a potential solution to healthcare system challenges through cohort identification, patient engagement, and access to relevant healthcare services, but their implementation must meet multiple requirements. This study of an EHR-integrated population health management platform implementation used an Evaluation in Life Cycle of Information Technology -grounded approach to identify implementation barriers and facilitators and implementation strategies to address barriers. An implementation toolkit is being refined to support the implementation and dissemination of population health management platforms.