Using Preventive Health Alerts in the Electronic Health Record Improves Testing Rates for Infants Perinatally-Exposed to Hepatitis C

BACKGROUND: Perinatal exposure to hepatitis C virus (HCV) is a major public health issue, as testing rates are poor and many infected patients remain unidentified. We sought to use the electronic health record (EHR) to improve testing rates among infants born to HCV-infected mothers in an urban, safety-net hospital system. METHODS: Our study population was identified using our EHR database (Hyperspace Epic 2014, EpicCare Systems, Verona, WI). Children were included in the study if they had perinatal HCV exposure, were between the ages of 18 months to 18 years, and had at least one encounter in primary or urgent care during the study period. Our study included retrospective (October 2011-Febrary 2015) and prospective (February 2015-May 2016) arms. Our EHR-based intervention, which we initiated in the prospective arm, linked the patient to a one-time HCV antibody test on or after the age of 18 months using a preventive health forecasting engine. The preventive health forecasting engine activated a point of care clinical advisory alert for all children with perinatal hepatitis C exposure. This alert was associated with an order for a HCV antibody test and would occur in all well child or urgent care encounters during the study period. RESULTS: 5.6% (7/125) of the patients with perinatal HCV exposure had a HCV antibody test performed on or after 18 months of age during the retrospective arm. After initiation of our EHR-based intervention, this proportion significantly increased to 18.7% (28/150) (P <0.002; CI, 1.6 to 9.2; OR, 3.9). CONCLUSION: Among patients with perinatal HCV exposure, using a point of care clinical advisory within the EHR significantly increased the rate of HCV antibody testing in accordance with American Academy of Pediatrics recommendations. However, a significant number of infants continue to not be appropriately tested. More EHR-based interventions combined with increased physician awareness of appropriate HCV testing in perinatally-exposed infants is imperative. DISCLOSURES: All authors: No reported disclosures.