Dr. Lori A. Orlando, MD MHS MMCI is a Professor of Medicine, health services researcher, and Director of the Precision Medicine Program at Duke University. She is the President of MeTree&You and an expert in applying informatics and implementation science to identifying and managing individuals at increased risk for medical conditions. In her 20-year career she has 80 publications, secured extensive grant funding, and speaks internationally about optimizing disease risk assessment. Her current research program focuses upon using technology to overcome barriers to family health history-based risk assessment and using high quality family health histories to guide clinical care.

Dr. Donna Crenshaw, PhD, MHA is the Associate Dean of Basic Science at the Duke University School of Medicine and the Director for Strategic Partnerships in Duke’s Pratt School of Engineering. She has 20+ years of experience in genomics, drug and diagnostics development, alliance management, competitor intelligence and technology evaluation, and intellectual property strategy and prosecution. Donna previously worked in the Competitor and Scientific Information and Pharmacogenetics groups at GlaxoSmithKline and as a research scientist at Duke. She has participated in the launch of three startup ventures, Zinfandel Pharmaceuticals, Inc., Predigen Inc., acquired in 2021, and MeTree&You.

Tejinder Rakhra-Burris, MA, Molecular Genetics has 20+ years in administration/program management of complex scientific research programs. An Associate in Research in the Duke Program in Precision Medicine, she has administrative/operational leadership continued from the Duke Center for Applied Genomics & Precision Medicine. She oversees proposal development, management and implementation of clinical research efforts, including research using the MeTree. She is Interim CEO/President of the Global Genomic Medicine Collaborative, which fosters global collaborations with a common thread of genomic medicine advancement, integration and implementation to improve health. She is a MeTree&You, Inc. Founder and holds the officer role of Secretary.

Dr. Ryanne Wu, MD, MHS is an Associate Professor of Medicine at Duke University. She is trained in Internal Medicine and Health Services Research. Her research focuses on the implementation and adaptation of precision medicine interventions into clinical care. As part of the MeTree team, she led the first international deployment of MeTree as part of a population sequencing program in Singapore and the first pilot of MeTree in a cancer population. She is part of the guideline curation team for MeTree’s algorithms and has led the development and publication of 9 MeTree research articles.

Dr. Elizabeth Hauser, PhD, MS, MHS is a Professor in the Department of Biostatistics and Bioinformatics at Duke University. She holds graduate degrees in Biostatistics and Epidemiology with a focus on human genetics. Her research interests include statistical methods development for the analysis of complex genetic traits, analysis of family data, gene-environment interactions, and integrated analysis of metabolomics and genomic data. She has worked on studies of cardiovascular disease, diabetes, aging, and cancer. She has nearly 40 years of research experience and published over 180 articles. She has worked with Dr. Orlando on research related to family health history since 2007.

Matthew Gauger is the Co-Founder and CTO of One Cow Standing, a software consulting company he founded with Nickie Buckner in 2006. Matt graduated from Duke University in 1999 with a bachelor’s degree in Computer Science. He has worked in software development for his entire professional career. One Cow Standing develops and maintains the MeTree application and provides technical advice to MeTree&You.

Nickie Buckner is the Co-Founder and CEO of One Cow Standing, a custom software development company in Durham, NC. Nickie has a BS in Mechanical Engineering and a Master of Computer Science from North Carolina State University. He has architected and built solutions for Fortune 500 companies, the Department of Defense, and numerous NIH and CDC funded grants ranging from antibiotic efficacy to HIV prevention. He serves in a technical advisory role to MeTree&You and hopes to promote the use of family health history data to improve clinical outcomes.

Sheila Horwitz’s career in financial services began at L.F. Rothschild, Unterberg Towbin in the 1970s, where her practice centered on fixed-income and she rose to head the Municipal Bond Department. After moving to Wertheim & Company in 1990, a series of mergers and acquisitions resulted in Sheila joining Morgan Stanley after its joint venture with predecessor firm Smith Barney in 2009. At Morgan Stanley, she continues her commitment to understanding each client need and helping them find solutions to the complexities that come with wealth, which has been one of the hallmarks of her service to clients throughout her career.


The idea for MeTree came about through the Genomedical Connection, a collaboration of Duke University, the University of North Carolina at Greensboro, and Cone Health system which was funded by the Department of Defense to develop a model for bringing genomic medicine into primary care. The model, called the Genomic Medicine Model, was developed using the Health Belief and Adult Learning Theory models and focused upon education in the community, education of providers, and the development of MeTree. The Genomic Medicine Model’s goals were to activate patients to become more motivated healthcare partners through their interactions with MeTree and their individualized patient risk reports, improve the quality of data collected by educating patients about what type of information they need to collect and how to collect it, improve adherence to risk-stratified evidence-based guidelines by providing clear action-oriented risk targeted recommendations for prevention and/or risk-management for each patient, and provide just-in-time education to providers through the provider risk reports. Learn more about the Genomic Medicine Model.

Department of Defense funding provided support to develop: the Genomic Medicine Model, including MeTree, a website for resources and documents, CME modules for physicians, as well as a pilot study of MeTree in 2 community-based primary care clinics at Cone Health in Greensboro, NC (there was a 3rd control clinic). This successful pilot showed that MeTree could be adopted into primary care practices without disruption to workflow, was useful to patients and providers, and found that a high number of primary care patients (44%) were at high risk for one of the pilot clinical decision support conditions (breast cancer, ovarian cancer, colon cancer, hereditary cancer syndromes, or thrombosis). See our publications to learn more about our protocol, development and validation, and user experience for this pilot project.

You can view a TV broadcast about the study.

About the members of the Genomedical Connection

We would like to acknowledge all those involved in the initial development of MeTree: Lori Orlando, Geoff Ginsburg, Adam Buchanan, Elizabeth R. Hauser, Astrid Agbaje, Charles Wilson, Blair Chesnut, Vincent Henrich, Carol Christianson, Karen Powell, Margaret Pericak-Vance, Jeff Vance, Susan Hahn, Susan Blanton, Celette Sugg Skinner, Colette Blach, Paul Kelly Marcom, Mark Donahue, William Scott, Marcy Speer, Pamela Lietz, Susan Letvak, Debra Wallace, Thomas Ortel, Richard Becker, Louise Ivanov, and Ellen Jones.

Development at Duke University
MeTree development continued at Duke University as a research platform with guidance and input from the following experts:
  • Paul Kelly Marcom, MD
  • Svati Shah, MD MHS
  • Thomas Ortel, MD PhD
  • Dagny P. Noeth, MS
  • Adam H. Buchanan, MS MPH CGC

MeTree&You, established by the Duke research team, licensed MeTree from Duke to allow broader use of the platform outside of the research environment.

The development and maintenance of the interface and infrastructure is led by:
  • Matthew Gauger, Co-Founder and CTO, One Cow Standing
  • Nickie Buckner, Co-Founder and CEO, One Cow Standing
  • Blair Chesnut, Director of data processing for Duke Center for Human Genetics
Feature Summary

MeTree is a web-based, patient-facing risk assessment tool that collects personal health information and family health history. The application collects personal history on diet, exercise, smoking, and clinical data to calculate the Gail, BRCApro, and Framingham scores, in addition to personal and family health history on many cancers, hereditary cancers, cardiovascular syndromes, and other conditions.

Algorithms are run based on current clinical guidelines used by primary care physicians to create patient and provider-directed risk assessment reports. MeTree provides clinical decision support to patients and providers for breast cancer, ovarian cancer, colon cancer, hereditary cancer syndromes, thrombosis, coronary artery disease, aortic aneurysm, ischemic cerebrovascular disease, hereditary cardiovascular diseases, type 2 diabetes, and hereditary liver diseases.

Additional features include:
  • Responsive web application
  • EMR integration via SMART-FHIR
  • HIPAA compliant hosting platform