Use of electronic health records to promote regular screening for hepatocellular carcinoma in persons with chronic hepatitis B or hepatitis C infection

Background: Hepatitis B (HBV) and hepatitis C virus (HCV) are infectious agents that place persons at-risk for hepatocellular carcinoma (HCC). Studies show that elevated alpha-fetoprotein (AFP) and alanine aminotransferase (ALT) in sera are associated with the occurrence and progression of HCC. In patients at-risk, electronic health records (EHR) can be used to promote regular serologic screening and facilitate early, at a potentially resectable stage, HCC detection. Methods: The Liver Disease and Hepatitis Program established an EHR-based HCV/HBV registry to improve patient tracking/management. Patients are Alaska Native or American Indian people who are members of a statewide integrated healthcare system. Biannually, patients are mailed a letter encouraging them to have a blood draw. Follow-up letters notify patients of their results or if additional testing is needed. Results: In 2006, 2,298 patients were on the HBV/HCV registry: 1,758 letters were sent to patients with a mailing address and 1,173 patients had Ан1 blood draw. Liver imaging was recommended for 55 patients with elevated AFP (Ан15 ng/ml) and 523 patients with elevated ALT (Ан40 ng/ml) were evaluated for antiviral treatment; 3 patients were diagnosed with HCC. Conclusions: Among HBV/HCV carriers, the use of EHR can serve to promote regular screening for HCC and potentially prevent negative clinical outcomes. As more US primary care practices covert to an EHR system, such systems could be used to target and screen Asian and other populations with a high incidence of HBV carriers and be useful in the monitoring of persons with diabetes and other chronic diseases.