Enhancing HIV Testing Practices: Routinizing Testing through Electronic Medical Record (EMR) Technology

Methods: Using electronic medical records (EMR), we established baseline and ongoing site-specific rates of missed opportunities and generated stakeholder buy-in for systems change in an urban safety-net hospital and associated community-based health centers. In July 2010, HIV testing once was added to the health maintenance (HM) checklist of our EMR and provider education was revised to facilitated small group discussion of case scenarios that focus on improving provider communication skills. RESULTS: Inpatient and outpatient encounters of patients 13 to 64 seen between 1/2008 and 12/ 2010 were reviewed. Patients previously diagnosed HIV+ were excluded. 524,074 outpatient and 49,046 hospitalized encounters met inclusion criteria and were analyzed to determine HIV testing status. Missed opportunities were defined as encounters in which a patient was not tested who had never been tested before. Missed opportunities were much greater for men than women at baseline. (86%- 2008 and 84.1% 2009 vs 59.1% 2008 and 57.2% in 2009) (P <.001). Post intervention, missed opportunities decreased to 70.4% for men and 47.7% for women (P <.001). Across the system, the proportion of encounters never ever tested for HIV decreased to 53.9% in the second half of 2010. The greatest improvement in testing occurred among minority men with missed opportunities decreasing to 66.4% for Black males and 69.9% for Hispanic males (P <.001) LESSONS LEARNED: EMR-based reminders supported by provider education effectively increased testing of those never tested and reduced disparities in HIV testing.