Montefiore Medical Center in the Bronx, New York, found that implementing an electronic medical record (EMR) prompt reminding providers to offer HIV testing to hospitalized patients resulted in a “large increase” in HIV testing, diversification in patients who were tested, and an increase in diagnoses made by screening (J Acquir Immune Defic Syndr 2017; doi:10.1097/QAI.0000000000001299). The findings show the potential of leveraging EMRs to expand HIV testing and positively affect HIV prevention outcomes, according to the authors.
The study involved two periods of standard testing when the EMR prompt was not in place and two periods of active testing when it was. During the two active periods providers received an EMR prompt suggesting that they offer HIV testing to hospitalized patients who either did not have an HIV test result in the EMR or had a high-risk diagnosis subsequent to their last negative HIV test result. Along with the prompt, providers would see an order set giving them several options: request that an HIV counselor offer the patient testing; order an HIV test and document that the provider obtained patient consent; document that the patient declined HIV testing, self-reported being HIV-positive, lacked capacity to consent, or was terminally ill. If providers did not select one of these order sets, the prompt would reappear every time they placed orders in the EMR for the patient in question.
During the two inactive periods, 9.5% of hospitalized patients had an HIV test, versus 21.8% when the EMR prompt was in place. The adjusted odds ratio for increased HIV testing for hospital admissions was 2.78 during the time the prompt was in place. The rate of new HIV diagnoses made by screening when the prompt was in place was 37.0/100,000 admissions, versus 8.2/100,000 during the inactive periods.