Table 4.

Primary Implementation Challenges

• Provider/stakeholder buy-in

• Establishing laboratory contracts with hospital

• EHR formatting of laboratory reports

• Development of clinical decision support

• Logistics of:  ○ sample collection in cardiac catheterization laboratory or as an outpatient  ○ location of rapid testing devices and freezers  ○ getting results to appropriate providers  ○ returning of results prior to patient discharge due to testing TAT  ○ implementation of therapy changes after patient discharge  ○ delays in therapy changes until after clinical decision alert fires in the EHR system  ○ notifying patients they were tested and of their results

• Acceptance of recommendations based on testing results

• Number of samples that needed to be recollected (for rapid testing platforms)

• Study design (for research implementations)

• Patient recruitment (for research implementations)

• Billing/reimbursement for pre-emptive testing