EHR prompt gives Michigan Medicine boost in hepatitis C screening

Alert also leads to dramatic increase in follow-up specialized care for those patients infected with the virus.

By using a prompt in its electronic health record system, Michigan Medicine has been able to improve the hepatitis C virus screening rate fivefold among Baby Boomers as well as increase follow-up specialty care for infected patients.

In a study comparing screening-eligible patients in the six months before the prompt was implemented with patients in the year after implementation, hepatitis C virus (HCV) screening rates increased from 7.6 percent to 72 percent. Results of the study were published online last week in the journal Hepatology.

In addition, 100 percent of newly diagnosed patients in the study were referred to specialty care, while 67 percent of patients were subsequently prescribed treatment—rates much higher than any previously reported to date.

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Screening of Baby Boomers is particularly important given that the population historically has an elevated prevalence of HCV infection. Nonetheless, screening rates remain very low, and experts estimate that only 50 percent to 65 percent of the estimated 3.2 million persons chronically infected with HCV in the United States are aware of their infection.

To address this deficiency, Michigan Medicine operates an EHR committee which determines those diseases treated by the health system that would benefit most from electronic prompts in their Epic system.

“The health system is trying to be very attuned to standard of care recommendations for screening,” says Monica Konerman, MD, a clinical lecturer at the University of Michigan. “One of the concerns had been that our providers were not able to meet the screening recommendations for hepatitis C.”

Konerman and her colleagues developed a prompt integrated into Michigan’s EHR to make it much easier for primary care physicians to conduct HCV screening and to help facilitate subsequent care for patients newly diagnosed with the infection. Before the electronic prompt was implemented, PCPs had to remember to screen for HCV in baby boom patients and to verify prior testing or diagnosis. However, clinicians are now prompted to do so.

According to Konerman, a “best practice advisory” prompts PCPs to perform HCV screening for patients seen in the clinic who are born between 1945 and 1965, lack a prior diagnosis of infection, and do not have prior documented testing.

“The way that we designed the prompt is we solicited feedback from primary care physicians and designed it with them in mind,” she says. “Fundamentally, what we wanted to do was to cut back on the workload that we were creating for the providers and make it easier for them to be able to meet these screening recommendations.”

One of the key elements in the design of the prompt is that it doesn’t impede the workflow of PCPs by only alerting them to patients that need to be screened and includes a pre-populated order set that requires just a single click, Konerman notes.

“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,” adds 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.”

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