In 2006, the Centers for Disease Control and Prevention (CDC) issued updated HIV screening guidelines recommending screening of all patients aged between 13 and 64 years. In 2013, the CDC updated its hepatitis C virus (HCV) testing guidelines to include all patients born between 1945 and 1965. As healthcare disparities continue to challenge the underserved community of Central Brooklyn, the optimization of HIV and HCV screening rates remains a notable hurdle. To meet this challenge, our institution created an opt-out order entry system in the electronic medical record (EMR), in conjunction with scripted questions and techniques in motivational interviewing, to optimize our screening rates for these viruses.
Beginning in December of 2015, our institution instituted EMR screens pre-populated with HIV and HCV lab orders at point of encounter. The presence of these orders in the EMR prompted discussion with the patient about these screening tests. Included in these pre-populated order sets were templates embedded in the EMR which provide a script for following the mandates of testing and post-test counseling.
During the 3 months prior to implementation of opt out screening, 130 patients were tested for HIV. Following EMR modification, this number rose to 403. Of the patients tested, our incidence for HIV infection was found to be 1.7%. Out of the 9 HIV-positive patients, 55.5% were female and 44.4% male. Self-identified Black patients accounted for 77.7% of total patients while the remaining 22.3% identified as Hispanic. With regards to HCV screening performed in the fourth quarter of 2015, 1248 patients were tested. Post-implementation, a 73% increase in HCV screening was noted. A total of 47.2% of patients screened were born between 1945 and 1965, while 52.8% were born outside the birth cohort. Overall prevalence of HCV antibody was 6.9%. 25 of the 1248 patients yielded a positive HCV RNA test.
In an effort to combat limited access to medical screening in an urban community hospital, an opt out order entry system was incorporated into the EMR. This novel approach not only expedites the process of testing and data analysis, but increases screening rates that allows for prompt diagnosis and patient linkage to care.
M. G. Centeno,
A. Gupta, None
V. Auguste, None
J. Donado, None
J. Paul, None
N. Pasco, None