Electronic Health Records (EHRs): A Role in Eliminating Disparities in HIV testing

Background: In 2006, CDC recommended all adults 13-64 have HIV screening once in their lifetime. Men account for ¾ of the HIV epidemic in the US. We previously reported that 17% of men and 55% of women receiving outpatient primary care (2008-2009) were ever tested within our publicly funded urban healthcare system, despite extensive provider education. Objective / Purpose: To study the effect of a HIV test reminder in the health maintenance checklist of an EHR, particularly among minority men. Methods: In July 2010, we modified our EHR to include a reminder for HIV serology once for all adults 13-64. Our EHR has all HIV tests done within our healthcare system since 1999. Office visits for 2010 from 5 community-based primary care clinics and 2 hospital-based primary care clinics were reviewed for eligible visits and HIV testing. Known HIV+ individuals were excluded. Rates of testing and missed opportunities pre/post intervention were analyzed. Results: 188,232 eligible encounters occurred among in 2010; 138,848 in females and 49,384 in males. Pre-intervention rates for first time testing were 2.0% for women and 2.9% for men. Post intervention, testing increased among all race/gender strata with doubling of first time testers observed in Black ((3.4%-6.9%), Hispanic (2.9%- 7.1%) and white men (1.9%-4.4%) as well as black women (2.1%- 4.2%) (each P <.001). New diagnoses from outpatient testing increased 24% in 2010 compared to 2008 and 2009. Increases in first time testing decreased missed opportunities for testing among minority men decreased from 76.5% to 67%. Discussion: EHR based reminders for single time HIV testing are an effective intervention that increases screening overall and decreases disparities in testing between men and women and especially among minority men.