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Impact of Integrating EMR HCV Testing Prompts in a Difficult to Navigate EMR System
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Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Tzarnas, S., Allen, M., Brodsky, A., Magaldi, L., Moy, C., Zivich, S., Trooskin, S. Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
"Baseline data in May showed that 6.9% of the 1,658 birth cohort patients seen were tested for HCV ......After prompts went live in July, 18% of the 1,807 birth cohort patients seen were tested for HCV"
program abstract
Background: At least 50% of individuals infected with HCV are unaware of their status. Furthermore, 50% of individuals with a reactive antibody test never receive a confirmatory test. Electronic Health Record (EHR) testing prompts that reflect CDC recommendations for birth cohort testing and the standard HCV screening algorithm have the potential to be a useful tool. We aim to describe the impact of these EMR modifications on primary care provider (PCP) testing practices.
Methods: EHR prompts began July 1 2014. Individuals born between 1945-1965 with no prior HCV testing had a prompt added that appeared under the patient's name reminding the PCP that the "Patient Needs HCV Screening". Any patient with a reactive antibody test or an ICD-9 code consistent with chronic HCV infection but no confirmatory test had a similar prompt added reminding the PCP that the "Patient needs HCV confirmatory testing". Educational sessions about CDC screening guidelines, testing algorithms and prompts were held at primary care practices to reinforce implementation. To simplify HCV test ordering options EHR technical staff removed orders for non-preferred tests such as older tests and redundant tests. Technical staff limited access to duplicate testing options. Providers were encouraged to use HCV antibody testing with reflex to PCR quantitative testing as the preferred method.
Results: Baseline data in May showed that 6.9% of the 1,658 birth cohort patients seen were tested for HCV. Of those tested, 18% were tested using non-preferred testing methods and only 4.4% were tested using the preferred method. June showed that 12% of the 1,609 birth cohort patients seen were tested for HCV; 8.7% were tested using non-preferred tests and 5.9% using the preferred test. After prompts went live in July, 18% of the 1,807 birth cohort patients seen were tested for HCV, only 2% were tested using the non-preferred tests and 42% were tested using the preferred test. In August 19.7% of the 1,628 birth cohort patients seen were tested, only 0.76% were tested using non-preferred tests and 59% were tested using the preferred test.
Conclusions: Prompts implemented in July were effective in increasing routine screening of the baby boomer birth cohort. There was a shift towards ordering tests that support the recommended testing algorithm. EHR prompts and provider education have the potential to increase the number of individuals aware of their HCV status.
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