245571 Electronic Health Records (EHRs): A Role in Eliminating Disparities in HIV testing

Tuesday, November 1, 2011: 2:30 PM

Ann Avery, MD , Division of Infectious Diseases, MetroHealth System, Cleveland, OH
Michelle Del Toro, MPH, MALS , Public Health and Research, Cleveland Clinic, Cleveland, OH
Peter Greco, MD , MetroHealth System, Cleveland, OH
David Kaelber, MD, PhD, MPH, FAAP, FACP , MetroHealth System, Cleveland, OH
Background: In 2006, CDC recommended all adults 13-64 have HIV screening once in their lifetime. Men account for 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.

Learning Areas:
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
By the end of the session, participants will be able to assess the disparity in HIV testing using EMR data. By the end of the session, participants will be able to evaluate the benefits of EMR based interventions to address preventive health needs. By the end of the session, participants will be able to develop a structural/ EMR based intervention to address this disparity in their system.

Keywords: Health Information Systems, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator for this project
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.