Previously submitted to: JMIR Formative Research (no longer under consideration since May 19, 2026)
Date Submitted: Sep 22, 2025
Open Peer Review Period: Sep 22, 2025 - Nov 17, 2025
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Challenges in the clinical use of digital tools in healthcare: barriers and blueprint for Kidney Failure Risk Equation implementation
ABSTRACT
Background:
Chronic kidney disease (CKD) affects approximately 10% of the global population and is a major contributor to morbidity and the need for kidney replacement therapy. The Kidney Failure Risk Equation (KFRE) is a validated risk prediction tool, yet its implementation remains limited.
Objective:
To identify barriers to KFRE implementation and propose a blueprint for integrating digital risk tools into healthcare systems.
Methods:
Narrative synthesis of barriers across domains (data infrastructure, clinician engagement, technology integration, and policy), informed by UK NHS case study experience.
Results:
Key barriers include low rates of urine albumin-creatinine ratio testing, assay and formula variability for eGFR, limited clinician awareness, fragmented IT systems, and insufficient policy alignment. Solutions include standardisation, embedding KFRE into LIMS/EHRs, automated calculation, and alignment with national strategies.
Conclusions:
Embedding KFRE into clinical workflows offers a model for digital risk tool integration. Addressing barriers across technical, educational, and policy domains is essential, and lessons are transferable to other digital health innovations. Clinical Trial: N/A
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