The impact of electronic medical record system implementation on HCV screening and continuum of care: a systematic review

Barter, Lauren; Cooper, Curtis

doi:10.1016/j.aohep.2021.100322

Cited by 13 publications

(11 citation statements)

References 15 publications

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“…In addition, we identified poor anti‐HDV screening rates among trainee clinics. The introduction of targeted quality improvement interventions in these settings, including EMR prompts and reflex HDV testing, may help improve screening rates, like established HCV screening initiatives 21 . Of the HBsAg‐positive patients that were screened ( n = 1444) in our cohort, 6% were positive for HDV.…”

Section: Discussionmentioning

confidence: 99%

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

Nathani

Leibowitz

Giri

et al. 2022

Journal of Viral Hepatitis

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Hepatitis D virus (HDV) infection is highly prevalent in patients with chronic hepatitis B (CHB). AASLD guidelines recommend a risk-based screening approach. Our aim was to ascertain if the risk-based approach leads to appropriate HDV screening, identify targets to improve screening rates, and study HDV clinical burden. CHB patients screened for HDV from 01/2016 to 12/2021 were identified. Level of training and specialty of providers ordering HDV screening tests were determined. HDV seropositive (HDV+) patient charts were reviewed for the presence of individual risk factors per the AASLD guidelines to determine if they met screening criteria. The severity of liver disease at the time of HDV screening was compared between the HDV+ group and a matched (based on age, hepatitis B e antigen status, BMI and sex) HDV seronegative (HDV−) group. During the study period, 1444/11,190 CHB patients were screened for HDV. Most screening tests were ordered by gastroenterology (90.2%) specialists and attending physicians (80.5%). HDV+ rate was 88/1444 (6%), and 72 HDV+ patients had complete information for analysis. 18% of HDV+ patients would be missed by a risk-based screening approach due to unreported or negative risk factors (see Table ). A significantly higher number of HDV+ patients had developed significant fibrosis (p = 0.001) and cirrhosis (p < 0.01) by the time of screening than HDV− (n = 67) patients. In conclusion, targeted interventions are needed towards trainees and primary care clinics to improve screening rates. Current risk-based criteria do not appropriately screen for HDV. It is time for universal screening of HDV in CHB patients.

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Section: Discussionmentioning

confidence: 99%

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

Nathani

Leibowitz

Giri

et al. 2022

Journal of Viral Hepatitis

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“…There are several other reports in the literature of EHR prompts or alerts improving rates of screening, specifically for HCV [ 9 – 14 , 17 – 19 ]. Most of the studies were completed when only the BC screening guidelines were in place.…”

Section: Discussionmentioning

confidence: 99%

“…With the advent of universal screening, the healthcare provider still needs to recognize which patients require their screening, and if re-testing is appropriate based on risk factors [ 7 , 8 ]. Fortunately, clinical decision support (CDS) alerts built into electronic health records (EHR) may lessen the burden of this responsibility [ 9 – 14 ]. Additionally, such alerts may improve screening rates and, ultimately, connection to care [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

HCV universal EHR prompt successfully increases screening, highlights potential disparities

et al. 2023

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Background & objectives Screening for hepatitis C virus is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an electronic health record (EHR) alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. Methods Data was abstracted from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody (Ab) screening dates. For a limited period centered on the implementation of the HCV alert, mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened. The final models included socio-demographic covariates of interest, time period (pre/post) and an interaction term between time period and sex. We also examined a model with time as a monthly variable to look at the potential impact of COVID-19 on screening for HCV. Results Absolute number of screens and screening rate increased by 103% and 62%, respectively, after adopting the universal EHR alert. Patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, 95% CI: 1.05, 1.15), while those with Medicare were less likely (ORadj 0.62, 95% CI: 0.62, 0.65); and Black (ORadj 1.59, 95% CI: 1.53, 1.64) race more than White. Conclusions Implementation of universal EHR alerts could prove to be a critical next step in HCV elimination. Those with Medicare and Medicaid insurance were not screened proportionately to the national prevalence of HCV in these populations. Our findings support increased screening and re-testing efforts for those at high risk of HCV.

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“… 16–18 Moreover, this study demonstrates the utility of an EMR-based ML algorithm in identifying HCV patients and evidences a potential benefit in deployment into clinical workflow. One way to realise this benefit is through integrating risk prediction algorithms into EMR systems, and examples of this exist; simple rule-based algorithms have been effective in increasing HCV screening rates, 15 while a recent study describes the integration of a complex sepsis prediction of ML algorithm with an Epic EMR system in the USA. 17 EMR integration can facilitate targeted HCV screening, which would have multiple potential clinical and operational benefits.…”

Section: Discussionmentioning

confidence: 99%

Finding undiagnosed patients with hepatitis C virus: an application of machine learning to US ambulatory electronic medical records

Rigg

Doyle

McDonogh

et al. 2023

BMJ Health Care Inform

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Aims To develop and validate a machine learning (ML) algorithm to identify undiagnosed hepatitis C virus (HCV) patients, in order to facilitate prioritisation of patients for targeted HCV screening. Methods This retrospective study used ambulatory electronic medical records (EMR) from January 2015 to February 2020. A Gradient Boosting Trees algorithm was trained using patient records to predict initial HCV diagnosis and was validated on a temporally independent held-out cross-section of the data. The fold improvement in precision (proportion of patients identified by the algorithm who are HCV positive) over universal screening was examined and compared with risk-based screening. Results 21 508 positive (HCV diagnosed) and 28.2M unlabelled (lacking evidence of HCV diagnosis) patients met the inclusion criteria for the study. After down-sampling unlabelled patients to aid the algorithm’s learning process, 16.2M unlabelled patients entered the analysis. Performance of the algorithm was compared with universal screening on the held-out cross-section, which had an incidence of HCV diagnoses of 0.02%. The algorithm achieved a 101.0 ×, 18.0 × and 5.1 × fold improvement in precision over universal screening at 5%, 20% and 50% levels of recall. When compared with risk-based screening, the algorithm required fewer patients to be screened and improved precision. Conclusions This study presents strong evidence towards the use of ML on EMR data for the prioritisation of patients for targeted HCV testing with potential to improve efficiency of resource utilisation, thereby reducing the workload for clinicians and saving healthcare costs. A prospective interventional study would allow for further validation before use in a clinical setting.

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The impact of electronic medical record system implementation on HCV screening and continuum of care: a systematic review

Cited by 13 publications

References 15 publications

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

HCV universal EHR prompt successfully increases screening, highlights potential disparities

Finding undiagnosed patients with hepatitis C virus: an application of machine learning to US ambulatory electronic medical records

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