Increasing HCV Screening Using Electronic Health Record Prompts

Despite the existence of effective treatments for hepatitis C (HCV), the disease eludes eradication, largely because of shortfalls in diagnosis and access to care. A study from the University of Michigan in Ann Arbor published in Hepatology¹ recently looked at the impact of electronic health record (EHR)-based prompts to screen baby boomers for HCV on improving rates of diagnosis and access to care and treatment for those newly diagnosed with HCV.

It is estimated that of the 3.2 million Americans chronically infected with HCV, only 50% to 65% are aware that they have it.^2-4 Because prevalence of HCV is 5 times higher among those born between 1945 and 1965 (baby boomers) than among other age groups, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend a one-time screen for all baby boomers, even those without traditional risk factors. However, such screening is done <30% of the time. Even when screening is done, subsequent care for those who test positive is low — estimated at 35%.

For the study, researchers  implemented an EHR best practice advisory (BPA) prompt to screen for HCV among baby boomers at 13 clinics near Ann Arbor, Michigan. The prompt included a designed procedure for follow up care and management – such as educational materials, order set, and streamlined access to specialty care – for people newly diagnosed with HCV. The researchers compared screening and care of those who were newly diagnosed with HCV for 37,289 clinical visits pre-BPA and 42,721 clinical visits post-BPA.

Results showed that the BPA increased screening 5-fold and enabled more people who had not been diagnosed with HCV and had advanced disease to be cured. Compared with 6 months pre-BPA, when only 7.6% of this age group were screened, during the one year post-BPA, 72% of patients in this age group were screened. Further, all 53 of those who were newly diagnosed with HCV were referred to specialty care, including 9 with advanced disease who were cured.

These findings suggest that implementing a prompt in EHRs in primary care settings to screen for HCV may help eradicate the disease. Researchers concluded, “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 HCV.”

References

1. Konerman MA, Thomson M, Gray K, et al. Impact of an electronic health record alert in primary  care on increasing hepatitis C screening and curative treatment for baby boomers [published online July 17, 2017]. Hepatology. doi:10.1002/hep.29362
2. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705-714.
3. Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. N Engl J Med. 2013;368:1859-1861.
4. National Academies of Sciences, Engineering and Medicine. A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report. Washington, DC: The National Academies Press; 2017.