To reduce complications and spread of HCV infections, patients must first be diagnosed and then connected with specialized care for their disease. Although there have been significant advances in therapy for chronic HCV infection, barriers to HCV elimination include deficiencies in screening and subsequent follow-up medical care. Screening of baby boomers is especially important because they have an elevated prevalence of HCV infection. One-time universal HCV screening is recommended for these individuals; however, screening rates in this population remain very low.
To address this problem, Monica Konerman, MD, MSc, of the University of Michigan, and her colleagues developed an EHR-based prompt in primary care clinics to increase screening rates and help facilitate subsequent care for patients newly diagnosed with HCV infection. The prompt eliminated the burden of work previously placed on clinicians to first remember the need for HCV screening in this population and secondly to verify prior HCV testing or diagnosis of individual patients.
The researchers compared information on 22,488 screening-eligible patients in the six months before the prompt was implemented with 27,789 patients in the year after implementation. HCV screening rates increased from 7.6% to 72% following implementation of the EHR prompt. The subsequent streamlined care facilitated 100% of newly diagnosed patients to be referred to specialty care, and 67% of patients were subsequently prescribed HCV treatment. These rates are much higher than any previously reported to date.
"Our EHR prompt was successful in significantly increasing overall HCV screening rates and in helping to get newly diagnosed patients connected with care and curative treatment for HCV," said Dr. Konerman. "This type of EHR-based intervention represents a low cost, efficient, and effective means to improve HCV screening, diagnosis, and access to care, which ultimately can lead to mitigation of the associated morbidity and mortality of chronic hepatitis C."
Monica A. Konerman, Mary Thomson, Kristen Gray, Meghan Moore, Hetal Choxi, Elizabeth Seif, Anna S.F. Lok.
Impact of an Electronic Health Record Alert in Primary Care on Increasing Hepatitis C Screening and Curative Treatment for Baby Boomers.
Hepatology; Published Online: September 14, 2017. doi: 10.1002/hep.29362.