Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population

Abstract

Objectives Indian Health Service (IHS) screening rates for Chlamydia trachomatis are lower than national rates of chlamydia screening in the Southwest. We describe and evaluate the effect of a public health intervention consisting of electronic health record (EHR) reminders to alert health care providers to screen for chlamydia at an IHS facility. We also conducted an awareness presentation among health care providers on chlamydia screening. Methods We conducted our intervention from November 1, 2013, through October 31, 2015, at an IHS facility in the Southwest. We implemented algorithms that queried database values to assess chlamydia screening performance in 6 clinical departments. We presented data on the screening performance of clinical departments and health care providers (de-identified) in the awareness presentations. We re-queried database values 1 and 2 years after implementation of the EHR reminder intervention to evaluate before-and-after screening rates, comparing data among all patients and among female patients only. Results We found small, sustained relative increases in chlamydia screening rates during the 2012-2015 evaluation period: 20.8% pre-intervention to 24.9% and 24.2% one and two years postintervention, respectively, across all patients; 32.3% preintervention to 36.6% and 35.6% one and two years postintervention, respectively, among female patients. Increases in clinical department–specific screening rates varied and were most prominent in internal medicine (35.8% preintervention to peak 65.8% postintervention). The 1 clinic (obstetrics–gynecology) that did not receive an awareness presentation showed a consistent downward trend in screening rates, although absolute rates were consistently higher in that clinic than in other clinics. Conclusions Awareness presentations that offer feedback to health care providers on screening performance, heighten provider awareness of the importance of chlamydia screening, and promote development of novel provider-initiated screening protocols may help to increase screening rates when combined with EHR reminders.

Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review

“…The six IHS studies showed the capability of implementing CDS to promote change over large geographic areas with externally-available population-specific CDS and quality improvement methods [33,34,36,40,42,64]. Beginning in 2004, federally operated IHS facilities began implementing a single EHR, Resource and Patient Management System (RPMS), that was developed for IHS with end-user input and major contributions for shared core applications from the Department of Veterans Affairs legacy EHR, Veterans Health Information Systems and Technology Architecture (VistA) [71,72].…”

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review

“…Six references described an outbreak response for syphilis 4 and gonorrhoea. 2 STI testing and treatment within the Indian Health System are primarily provided in outpatient clinics and emergency departments 37,[73][74][75][76][77][78][79][80][81] and are delivered according to national guidelines. 73 Expedited partner therapy (EPT) is available in some clinical settings.…”

“…83,84 Clinical decision support in electronic health records is utilised at many facilities as testing bundles or screening reminders for bacterial STIs and HIV with a single order set to enhance screening. [76][77][78][79] In some situations, such as outbreaks or in review of local epidemiology, STI screening and clinical decision support can be expanded based on local policy and practice needs. 77,80,81 In comparison to non-Hispanic Whites, AI/AN men and women have been reported to more likely seek STI services.…”

An electronic health record alert increases human immunodeficiency virus screening and case identification in a high-risk emergency department population

“…3 Clinical decision support tools integrated into the electronic health record (EHR) have been used to increase screening for multiple conditions in primary care. 4,5,6 Alerts must be userfriendly and integrate smoothly into clinical workflows. 7,8,9 This quality improvement (QI) study describes implementation of an EHR alert to facilitate routine opt-out screening for HIV in an urban academic ED and reports the number of patients successfully linked to care.…”

“…3 Clinical decision support tools integrated into the electronic health record (EHR) have been used to increase screening for multiple conditions in primary care. 4,5,6 Alerts must be user-friendly and integrate smoothly into clinical workflows. 7,8,9…”