New EHR Alert Increases HCV Screening Among Baby Boomers

Implementation of an electronic health record-based prompt significantly increased hepatitis C screening rates among baby boomers in primary care. According to the researchers, HCV screening among adults born between 1945 and 1965 increased fivefold during a 1-year period following implementation of the Best Practice Advisory (BPA) EHR alert.

“Although there has been dramatic advances in therapy, there remain significant barriers to HCV elimination including deficiencies in screening and subsequent linkage to care,” Monica A. Konerman, MD, MSc, from the University of Michigan, told Healio.com/Hepatology. “Despite evidence-based recommendations, uptake of one-time universal HCV screening among baby boomers remains low. Various approaches have been evaluated to optimize screening rates, but most fall short in their ability to confirm diagnosis and plug patients into specialty care. Primary care providers (PCPs) are uniquely positioned to have a high impact from HCV screening as continuity of care with patients facilitates follow-up throughout the HCV care cascade.”

The BPA alerts users when a patient is born between 1945 and 1965, lacks a prior EHR ICD-9 or ICD-10 diagnosis code for HCV, and/or lacks documented anti-HCV testing after 2009. However, the alert does not require order testing or a reason for not testing for a primary care physician (PCP) to continue in the EHR.

“There has been concern about ‘alert fatigue,’ particularly on the part of PCPs who are asked to screen for numerous conditions within time constrained visits,” the researchers wrote. The lack of a “hard stop” was favored by primary care physicians, according to feedback from a 3-month pilot run of the alert. “Lastly, we incorporated educational materials for both patients and the medical staff in order to help decrease anxiety related to screening, reduce work load for PCP clinics, and to make it easy for staff to provide rationale for screening and explanation of subsequent results.”

During the 3 years prior to the BPA implementation, 52,660 patients in the baby boomer cohort visited a PCP at least once. Of the 28% who received HCV screening in that time, screening was performed more often among men than women (31% vs. 26%; P < .001), African-American and Asian patients than Caucasian and other ethnicities (34% and 36% vs. 27% and 29%; P < .001), and patients with Medicaid or Medicare than those with commercial insurance (34% and 32% vs. 27%; P < .001). Additionally, there were varying rates of HCV screening across clinic specialties, ranging from 19% to 34% (P < .001).

Compared with 6 months prior to BPA implementation, the rate of anti-HCV orders increased from 4.6% to 47% in eligible visits and from 7.6% to 72% in eligible patients during the 1-year period after the BPA was added to EHR alerts. The percentage of patients with positive anti-HCV results who had detectable HCV RNA was significantly lower in the BPA period (33% vs. 74%; P < .001).

“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 CHC,” Konerman concluded in her comments to Healio.com/Hepatology. “Our intervention was extremely well received by PCPs who stated that unlike many EHR alerts that can be frustrating and slow down clinic work-flow, this EHR alert was efficient and helpful to both the providers and patients.

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