Making a Big Impact on Expanding HIV Inpatient Testing with a Small EHR Modification

BACKGROUND: The CDC estimates over 1.2 million Americans are living with HIV and, of those, approximately 14% are unaware of their HIV-positive status. Since 2014, most hospitals adopted some form of Electronic Health Records (EHR) and the Centers for Medicare & Medicaid Services extended Medicare coverage for annual HIV screenings. Despite these developments, there has been limited progress in expanding HIV testing in inpatient settings. The present study was conducted at Jersey City Medical Center (JCMC) in an effort to expand HIV testing by implementing EHR modification in the form of testing prompts. METHODS: This study began on January 1, 2016 at JCMC, a teaching hospital that passed all lab work orders through an EHR system. The number of daily orders for HIV screenings was recorded for 145 consecutive days before EHR modification (n = 145) to establish baseline data. EHR modification occurred on the 146th day of the study (May 25, 2016). This modification featured testing prompts displaying CDC guidelines for screening patients over the age of 18 for HIV whenever a physician ordered lab work for admitted patients. Orders for HIV screenings on this transitional date were excluded from analysis. After EHR modification was completed, the number of daily orders for HIV screenings was recorded for an additional 145 consecutive days (n = 145) for comparison. Testing data was available for all 145 consecutive days before and 145 consecutive days after EHR modification. RESULTS: Since the beginning of this study—before testing prompts were implemented—JCMC inpatient units ordered an average of 8.53 (SD=3.25) HIV screenings per day. The average number of daily orders for HIV screenings increased twofold after EHR modification (M=17.39, SD=4.26), t(288) = 19.90, P < .001. JCMC identified 86 HIV-positive and linked over 90% of these patients to care. CONCLUSION: Conventional HIV screening methods in the inpatient setting might not be sufficient at detecting most HIV-positive cases. By implementing testing prompts in its EHR system to encourage increased testing for HIV, Jersey City Medical Center was able to increase the number of individuals aware of their HIV status and link them to care as needed. DISCLOSURES: T. Nguyen, Gilead FOCUS: Employee, Grant recipient