Electronic medical record (EMR) reminders may be a valuable addition to screening protocols to successfully identify baby boomers with hepatitis C infection, and facilitate not only their referral to specialists, but successful treatment and cure as well, according to a recent study published in the Journal of Viral Hepatitis.
According to data from the 2003-2010 National Health and Nutrition Examination Survey, a full 75% of those infected with hepatitis C in the United States were baby boomers, born between the 1945-1965. Consequently, the US Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC) recommend one-time hepatitis C screening in this population to increase chances for early treatment and decrease the spread of hepatitis C.
Researchers undertook this prospective study to assess whether EMR reminders can be used by clinicians as a screening tool for hepatitis C in baby boomers, as well as to determine whether post-intervention with an EMR reminder would increase the number of patients screened, and subsequently referred and cured of hepatitis C.
They included 30,443 patients born 1945-1965 who had been seen twice in outpatient clinics in central Texas, excluding those with a previous diagnosis of chronic hepatitis C. Researchers compared screening and cure rates in these patients both before and after the implementation of an EMR reminder for screening.
They found that between February 2014 and February 2015, 1.87% of baby boomers had been screened, compared with 14.14% during the 12 months following EMR intervention in February 2015.
Before the intervention, two patients with a positive anti-hepatitis C virus (HCV) test were positive for HCV-RNA according to polymerase chain reaction. Although both patients were referred to an infectious disease clinic, only one attended and was cured, which researchers defined as a sustained virologic response (an undetectable HCV-RNA level) at 12 weeks after completion of treatment.
After the intervention, 32 patients among those who screened positive for anti-HCV were HCV-RNA positive, and all were referred to infectious disease or gastroenterology specialists for treatment. Nineteen patients were treated and 16 were cured.
Their results were favorable: In the year before this EMR intervention was implemented, 2,644 baby boomers were screened for hepatitis C and only 1 was cured. After implementation of the EMR reminder, an additional 27,370 were screened and 17 were cured.
Careful consideration of physician workflow is merited before the implementation of any additional EMR reminders, the authors cautioned. But the goal should the creation of an easy workflow that results in measurable results and positive patient outcomes.
“The current design embedded the hepatitis C labs into both the Best Practice Advisory and the Health Maintenance tab, giving providers easy access to order hepatitis C testing and limiting EMR fatigue while meeting Medicare rules, [CDC] requirements for screening, and ultimately increasing referrals to specialists for treatment for hepatitis C,” wrote senior author Dawn Sears, MD, Gastroenterology, Scott & White Medical Center-Temple, Temple, TX, and fellow researchers.
The outcomes of their particular intervention met these goals.
“By identifying asymptomatic patients with hepatitis C by EMR in Baylor Scott & White’s health-care–wide system, physicians increased the number of patients who were cured from hepatitis C infection. A unified use of EMR reminders to screen baby boomers will reduce overall morbidity and deaths related to hepatitis C,” they concluded.