HCV Screening Orders in Health Records Improve Surveillance

Shivan J. Mehta, MD, MBA, MSHP

Implementing an order for hepatitis C virus (HCV) screening in electronic health records could be a viable option in identifying and treating cases as early as possible.

A team, led by Shivan J. Mehta, MD, MBA, MSHP, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, evaluated whether a default order within the admission order set increases HCV screening compared to a preexisting alert within the electronic health record.

Hepatitis C Screenings

Despite recommendations for universal HCV screenings for individuals born between 1945-1965, rates remain low.

“A large barrier to increasing HCV screening is human behavior—clinicians need to be aware of guidelines and order the test, and patients need to accept the offer to complete screening,” the authors wrote. “The electronic health record (EHR) offers a scalable way to implement nudges, but these need to be designed to reduce clinician effort and burden.”

Wedge Approach

In the stepped-wedge randomized clinical trial, the investigators examined data between June 23, 2020 and April 10, 2021 at 2 hospitals within an academic medical center on hospitalized patients born between that time frame with no history of screening.

During wedge 1, which was a preintervention period, both sites had an electronic alert prompting clinicians to consider HCV screenings. In the second wedge, the hospital site (hospital B) was randomized to intervention with a default order for HCV screening implemented within the admission order set.

In the final wedge, the hospital site (hospital A) was randomized to control and had the default order set implemented.

The investigators sought main outcomes of the percentage of eligible patients who received HCV screening during the hospital stay. Overall, there were 7634 patients included in the study, 4405 in the control group and 3229 in the intervention group. The mean age of the patient population was 65.4 years, while 55.6% (n = 4246) of the patients were men. In addition, 37.8% (n = 2885) of the patient population had commercial insurance and 51.7% (n = 3950) had Medicare.

Increased Screenings

In wedge 1, the baseline rate of HCV screening was 37.5% (n = 585; 95% CI, 35.1-40.0%) in hospital A and 30.8% (n = 309; 95% CI, 27.9-33.7%) in hospital B.

Using a main adjusted model, the investigators found an increase of 31.8 (95% CI, 29.7-33.8) percentage points in test completion in the intervention group compared to the control group (P <.001).

“This stepped-wedge randomized clinical trial found that embedding HCV screening as a default order in the electronic health record substantially increased ordering and completion of testing in the hospital compared with a conventional interruptive alert,” the authors wrote.

Treatment for HCV has improved drastically in recent years with the advent of antiviral directing-acting agents that result in sustained virologic response in more than 95% of treated patients.

The study, “Effect of a Default Order vs an Alert in the Electronic Health Record on Hepatitis C Virus Screening Among Hospitalized Patients,” was published online in JAMA Network Open.