Department of Infectious Diseases, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Front Public Health. 2024 May 20;12:1281079. doi: 10.3389/fpubh.2024.1281079. eCollection 2024.
Many individuals living with hepatitis C virus (HCV) are unaware of their diagnosis and/or have not been linked to programs providing HCV care. The use of electronic medical record (EMR) systems may assist with HCV infection identification and linkage to care.
In October 2021, we implemented HCV serology-focused best practice alerts (BPAs) at The Ottawa Hospital (TOH) via our EMR (EPIC). Our BPAs were programmed to identify previously tested HCV seropositive individuals. Physicians were prompted to conduct HCV RNA testing and submit consultation requests to the TOH Viral Hepatitis Program. We evaluated data post-BPA implementation to assess the design and related outcomes.
From 1 September 2022 to 15 December 2022, a total of 2,029 BPAs were triggered for 139 individuals. As a consequence of the BPA prompts, nine HCV seropositive and nine HCV RNA-positive individuals were linked to care. The proportion of total consultations coming from TOH physicians increased post-BPA implementation. The BPA alerts were frequently declined, and physician engagement with our BPAs varied across specialty groups. Programming issues led to unnecessary BPA prompts (e.g., no hard stop to the prompts even though the individual was treated and cured and individuals linked to care without first undergoing HCV RNA testing). A fixed 6-month lookback period for test results limited our ability to identify many individuals.
An EMR-based BPA can assist with the identification and engagement of HCV-infected individuals in care. However, challenges including issues with programming, time commitment toward BPA configuration, productive communication between healthcare providers and the programming team, and physician responsiveness to the BPAs require attention to optimize the impact of BPAs.
许多患有丙型肝炎病毒 (HCV) 的人不知道自己的诊断结果，或者尚未与提供 HCV 护理的项目联系。电子病历 (EMR) 系统的使用可能有助于识别 HCV 感染并将其与护理联系起来。
2021 年 10 月，我们通过 EMR（EPIC）在渥太华医院 (TOH) 实施了 HCV 血清学重点最佳实践警报 (BPA)。我们的 BPA 旨在识别之前检测到 HCV 血清阳性的个体。医生被提示进行 HCV RNA 检测并向 TOH 病毒性肝炎计划提交咨询请求。我们在 BPA 实施后评估数据，以评估设计和相关结果。
从 2022 年 9 月 1 日至 2022 年 12 月 15 日，共触发了 2,029 个 BPA，涉及 139 人。由于 BPA 提示，有 9 名 HCV 血清阳性和 9 名 HCV RNA 阳性的个体与护理联系起来。BPA 实施后，来自 TOH 医生的总咨询量增加。BPA 警报经常被拒绝，并且医生与我们的 BPA 的参与度因专业组而异。编程问题导致不必要的 BPA 提示（例如，即使个体已经接受治疗并治愈，并且在没有首先进行 HCV RNA 检测的情况下与护理联系，也没有硬性停止提示）。用于测试结果的固定 6 个月回溯期限制了我们识别许多个体的能力。
基于 EMR 的 BPA 可以帮助识别和参与 HCV 感染个体的护理。然而，编程问题、配置 BPA 的时间承诺、医疗保健提供者和编程团队之间的有效沟通以及医生对 BPA 的响应性等挑战需要引起关注，以优化 BPA 的影响。
