Challenges in the clinical use of digital tools in healthcare: barriers and blueprint for Kidney Failure Risk Equation implementation (Preprint)

<sec> <title>BACKGROUND</title> 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. </sec> <sec> <title>OBJECTIVE</title> To identify barriers to KFRE implementation and propose a blueprint for integrating digital risk tools into healthcare systems. </sec> <sec> <title>METHODS</title> Narrative synthesis of barriers across domains (data infrastructure, clinician engagement, technology integration, and policy), informed by UK NHS case study experience. </sec> <sec> <title>RESULTS</title> 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. </sec> <sec> <title>CONCLUSIONS</title> 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. </sec> <sec> <title>CLINICALTRIAL</title> N/A </sec>