Evaluating electronic medical record based screening protocol on hepatitis c screening and linkage to care

Background and Objectives: The Emergency Department (ED) is potentially a high-yield site in health care to reach patients at risk for the hepatitis C virus (HCV) infection, the most common chronic bloodborne pathogen in the United States. Of the 71 million HCV-infected individuals globally in 2017, only an estimated 19% were aware of their positive HCV status. If EDs can identify the infected patients, this is a step toward reducing new hepatitis infections and death due to HCV, goals set by the World Health Organization to be reached by 2030. The primary aim of this project is to determine the effectiveness of upgrading the laboratory infrastructure to enable routine HCV ribonucleic acid (RNA) reflex testing and determine its effect on linking patients to care. Methods: An automated HCV screening protocol was implemented into the EPIC electronic medical record (EMR). The system screens patients born from 1945 through 1965 and/or those with a history of intravenous drug use, two identified risk factors for HCV set by the Center for Disease Control and Prevention. A best practice advisory (BPA) notifies providers to order an HCV antibody (Ab) test for patients with an ordered complete blood count with at least one risk factor. Positive HCV Ab test triggers a second BPA, prompting a HCV RNA test. In January 2019, HCV RNA reflex testing began where the RNA test would be automatically ordered after a positive Ab result. Linkage to care team followed up with patients until they attended their first visit with a qualified provider. The data analysis is inclusive of data obtained between August 2018 and November 2019. Results: HCV Ab tests were performed on 9,704 patients. Prior to RNA reflex implementation, out of the 445 patients who tested positive for HCV Ab, 220 had HCV RNA test performed (49.4%). After the revised protocol, out of 671 patients who tested positive for HCV Ab, 601 had RNA test performed (90%). Before RNA reflex testing was initiated, 66 patients were linked to care versus 126 patients were linked to care after the implementation, an increase of 66%. Conclusion: A significantly higher percentage of patients with positive HCV Ab testing had HCV RNA tests completed after the implementation of routine HCV RNA reflex testing. Connection to care rates also increased. Overall, the utilization of BPA capability of an EMR system may be an invaluable tool in efforts to reduce the prevalence of HCV