Sustained and cumulative impact of an electronic medical record-based alert on a hepatitis C birth cohort screening programme

Analyzing the medical record homepages quality in a Chinese EMR system

BACKGROUND

The medical record homepage represents the core and quintessential distillation of the entire medical record. This study aims to investigate the problems with the medical record homepages data quality after the upgrade of the electronic medical record system, while simultaneously proposing practical and feasible measures to catalyze substantive improvements in data quality standards.

METHODS

A retrospective analysis of data extracted from the medical record homepage system was conducted at a Chinese tertiary hospital affiliated with a medical university between January and December 2021. Analysis of Moment Structures (AMOS) was used to construct a structural equation model, with the aim of elucidating the influence of individual variables on dependent variables. Furthermore, a fish bone diagram analysis was utilized to systematically analyze the underlying causes of quality defects.

RESULTS

Among the 2,731 medical record homepages subjected to scrutiny, a substantial proportion of 1,531 records (56.1%) exhibited quality issues. The structural equation model revealed that patient demographic information exerted the most profound influence on data quality, as evidenced by the greatest value of the standardized total effects (β = -0.729), followed by surgery (β = -0.606) and diagnosis information (β = -0.363). Moreover, the fish-bone diagram analysis was employed to systematically dissect the underlying causes of quality defects in the medical record homepages, encompassing human factors, surroundings, regulatory system, and machinery.

CONCLUSIONS

The predominant factor contributing to the poor data on the medical record homepage was inaccuracies in demographic information, closely followed by errors in surgical and diagnosis information. It is helpful to improve the data quality of the medical record homepages by establishing a coder qualification certification system, strengthening the construction of medical informatization, and adding data validation and prompt functions.

Successes and challenges of best practice alerts to identify and engage individuals living with hepatitis C virus

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction

The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.

Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System

CONTEXT

Birth cohort ("baby boomer") screening represents a well-validated strategy for the identification of asymptomatic hepatitis C-infected patients. However, successful linkage of newly diagnosed patients to antiviral therapy has been more difficult to accomplish.

OBJECTIVE

To analyze the results of a systemwide birth cohort screening program in a US community health care system.

DESIGN

We analyzed the data from an ongoing hepatitis C virus (HCV) screening and treatment program that was established at NorthShore University Health System in 2015. Hepatitis C virus screening by primary care providers was prompted through automated Best Practice and Health Maintenance alerts. Patient visits and screening orders were tracked using a customized HCV dashboard. Virologic, demographic, and treatment data were assessed and compared with those of a cohort of patients with previously established HCV infection.

RESULTS

Since program inception, 61 8161 (64.3%) of the entire NorthShore baby boomer population of 96 001 patients have completed HCV antibody testing, and 160 patients (0.26%) were antibody positive. Of 152 antibody-positive patients who underwent HCV RNA testing, 53 (34.2%) were viremic. A total of 39 of 53 patients (73.6%) underwent antiviral therapy and achieved a sustained virologic response. Compared with patients identified through screening, a comparison cohort of patients with previously established HCV had more advanced fibrosis and significantly lower dropout rates. The COVID-19 pandemic was associated with a decrease in the number of outpatient visits of screening-eligible patients and with a reduction in HCV screening rates.

CONCLUSION

Our data demonstrate the electronic medical records-assisted systemwide implementation of HCV birth cohort screening and successful linkage to antiviral therapy in a community-based US multihospital system.