Electronic Medical Alerts Increase Screening for Chronic Hepatitis B: A Randomized, Double-Blind, Controlled Trial

Abstract

Implementation of screening recommendations for chronic hepatitis B (CHB) among foreign-born persons at risk has been sub-optimal. The use of alerts and reminders in the electronic health record (EHR) has led to increased screening for other common conditions. The aim of our study was to measure the effectiveness of an EHR alert on the implementation of hepatitis B surface antigen (HBsAg) screening of foreign-born Asian and Pacific Islander (API) patients. We used a novel technique to identify API patients by self-identified ethnicity, surname, country of origin, and language preference, and who had no record of CHB screening with HBsAg within the EHR. Patients with Medicare and/or Medicaid insurance were excluded due to lack of coverage for routine HBsAg screening at the time of this study. At-risk API patients were randomized to alert activation in their EHR or not (control). A total of 2,987 patients met inclusion criteria and were randomized to the alert ( = 1,484) or control group ( = 1,503). In the alert group, 119 patients were tested for HBsAg, compared with 48 in the control group (odds ratio, 2.64; 95% confidence interval, 1.88-3.73; < 0.001). In the alert group, 4 of 119 (3.4%) tested HBsAg-positive compared with 5 of 48 (10.4%) in the control group ( = 0.12). An EHR alert significantly increased HBsAg testing among foreign-born APIs. Utilization of EHR alerts has the potential to improve implementation of hepatitis B-screening guidelines.

The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure

“…The majority of people with CHB live in countries that now have national viral hepatitis plans [11]. Many of these plans encompass population-specific communications campaigns to improve awareness and promote testing [12]; community-based programs to provide testing and linkage to care to under-served and high-risk communities [13][14][15]; and pilot projects integrating HBV testing and care into health systems to improve the capacity of primary care providers to test and manage people with CHB [15][16][17][18][19].…”

Electronic health record alerts enhance mass screening for chronic hepatitis B

“…With the goal of enhancing clinical decision support related to CHB testing, we have previously published the results of a randomized trial of an electronic health record (EHR)-based alert designed to populate in electronic medical charts of at-risk API with private insurance. We found that the alert caused a more than twofold increase in completion of hepatitis B surface antigen (HBsAg) testing compared to controls after 1 year, but did not increase rates of HBsAg positive tests 9 . At that time, patients with public insurance were excluded due to concerns of costs to patients.…”

“…The statistical methods used were previously described 9 . Proportions between the EHR alert and control groups were compared using Fisher's exact test.…”

“…The deployment of the EHR alert was previously described 9 . It was deployed through the health system's electronic record (Epic Systems, Verona, WI) under the "Health Maintenance" functionality, which provides reminders for periodic health screenings and preventive care, starting January 28, 2016 to the present day.…”

A Best Practice Alert for Identifying Hepatitis B–Infected Patients

“…Our results are similar to those of Chak et al who created an EHR alert to improve HBV screening in Asian and Pacific Islanders within the UC Davis health system. 7 Together, these studies illustrate an EHR alert's ability to assist busy clinicians in providing comprehensive care to diverse patient populations. In both studies, BPA development required collection of granular demographic data (e.g., race, ethnicity, preferred language, and country of origin).…”