Differences among specialists in using the Electronic Medical Record alert system for HCV screening in outpatients at a large general hospital

Abstract

Background & objectives Some hepatitis C virus (HCV) patients remain underdiagnosed at a large hospital. The electronic medical record (EMR) alert system can increase in-hospital screening. This study evaluates the effectiveness of screening among outpatients and assesses variations in physician engagement across different specialties. Methods From December 2022 to April 2023, outpatients aged 45–79 years, with diabetes mellitus or chronic kidney disease, who did not have anti-HCV data in their EMR were identified. A pop-up alert prompted physicians to either order anti-HCV testing or refer patients for a health check-up. The frequency of alerts, physician response rates, blood test completion rates, and HCV seropositivity were analyzed by specialty. Results Of 85,320 alerts generated, 61.4% elicited a physician response. Internal Medicine clinics had significantly higher response rates than non-Internal Medicine clinics (77.5% versus 44.6%, P < 0.01). Among patients with physician responses, 30.9% completed the study, with markedly higher completion when blood tests were directly ordered compared to referrals (88.4% versus 7.2%, P < 0.01). The monthly number of screenings increased tenfold after the system was implemented. Overall, 22,377 patients (26.2%) were screened, and 485 (2.17%) were seropositive. One-fourth of seropositive cases were identified in non-Internal Medicine clinics, where the positivity rate was higher (2.7% versus 2.04%, P = 0.01). Conclusions Short-term use of the EMR alert system increased HCV detection among outpatients. The default test orders in the EMR improved completion rates more than referrals to a health check-up. There were differences in physician engagement and seropositive case detection among specialties. Targeted interventions, particularly among specialties with lower engagement, are necessary to improve the success of HCV screening.