Medford-Davis Laura N, Yang Katharine, Pasalar Siavash, Pillow M Tyson, Miertschin Nancy P, Peacock William F, Giordano Thomas P, Hoxhaj Shkelzen
a Department of Emergency Medicine , University of Pennsylvania , Philadelphia , PA , USA.
b Department of Medicine, Section of Emergency Medicine , Baylor College of Medicine , Houston , TX , USA.
AIDS Care. 2016;28(5):566-73. doi: 10.1080/09540121.2015.1127319. Epub 2016 Jan 5.
Early HIV detection and treatment decreases morbidity and mortality and reduces high-risk behaviors. Many Emergency Departments (EDs) have HIV screening programs as recommended by the Centers for Disease Control and Prevention. Recent federal legislation includes incentives for electronic health record (EHR) adoption. Our objective was to analyze the impact of conversion to EHR on a mature ED-based HIV screening program. A retrospective pre- and post-EHR implementation cohort study was conducted in a large urban, academic ED. Medical records were reviewed for HIV screening rates from August 2008 through October 2013. On 1 November 2010, a comprehensive EHR system was implemented throughout the hospital. Before EHR implementation, labs were requested by providers by paper orders with HIV-1/2 automatically pre-selected on every form. This universal ordering protocol was not duplicated in the new EHR; rather it required a provider to manually enter the order. Using a chi-squared test, we compared HIV testing in the 6 months before and after EHR implementation; 55,054 patients presented before, and 50,576 after EHR implementation. Age, sex, race, acuity of presenting condition, and HIV seropositivity rates were similar pre- and post-EHR, and there were no major patient or provider changes during this period. Average HIV testing rate was 37.7% of all ED patients pre-, and 22.3% post-EHR, a 41% decline (p < 0.0001), leading to 167 missed new diagnoses after EHR. The rate of HIV screening in the ED decreased after EHR implementation, and could have been improved with more thoughtful inclusion of existing human processes in its design.
早期检测和治疗艾滋病毒可降低发病率和死亡率，并减少高危行为。许多急诊科都按照疾病控制与预防中心的建议开展了艾滋病毒筛查项目。近期的联邦立法包括鼓励采用电子健康记录（EHR）。我们的目标是分析转换为电子健康记录对一个成熟的基于急诊科的艾滋病毒筛查项目的影响。在一个大型城市学术急诊科进行了一项电子健康记录实施前后的回顾性队列研究。对2008年8月至2013年10月期间的病历进行了艾滋病毒筛查率审查。2010年11月1日，整个医院实施了全面的电子健康记录系统。在实施电子健康记录之前，医生通过纸质订单要求进行实验室检查，每份表格上都自动预选了HIV-1/2检测。新的电子健康记录中没有重复这种通用的订单协议；相反，它要求医生手动输入订单。我们使用卡方检验比较了电子健康记录实施前后6个月的艾滋病毒检测情况；实施前有55054名患者就诊，实施后有50576名患者就诊。电子健康记录实施前后患者的年龄、性别、种族、就诊病情严重程度和艾滋病毒血清阳性率相似，在此期间患者和医生没有重大变化。实施电子健康记录之前，所有急诊科患者的平均艾滋病毒检测率为37.7%，实施后为22.3%，下降了41%（p<0.0001），导致电子健康记录实施后有167例新诊断病例漏诊。实施电子健康记录后，急诊科的艾滋病毒筛查率下降了，如果在设计中更周全地纳入现有的人工流程，筛查率可能会得到提高。
