EHR Optimization Doubles HCV Screening, Cuts Clinician Burden

An EHR optimization doubled completion rates of hepatitis C virus (HCV) screening while cutting down on clinician burden, according to a study published in JAMA Network Open.

HCV attacks the liver and is a leading cause of cirrhosis, cancer, and the need for liver transplants. While national guidelines recommend HCV screening for all adults, screening rates remain low.

A University of Pennsylvania research team made HCV screening a default order for patients who met guidelines at two different hospitals.

They then compared screening rates to a pre-existing alert system that required doctors to respond to a pop-up to make a screening order. Under the new system, a patient recommended for screening already had the screening order in their EHR admission order-set, and the physician only needed to click if they disagreed.

The researchers studied over 7,500 patient encounters, with about 4,400 patients under the pre-existing alert system and approximately 3,200 with the no-click default system.  

Overall, the HCV screening rate doubled among patients seen in the no-click system.

Completed screenings – patients who had the screening ordered and followed through – jumped from 42 percent of those in the alert system having a screening to 80 percent in the no-click system.

“We expected there to be an increase in ordering, but not to this magnitude, since we were comparing the default order to a pop-up alert that already existed in the electronic health record,” Shivan Mehta, MD, associate chief innovation officer at Penn Medicine, noted in a press release.

“The default order reduced effort by the clinicians by aligning the preferred choice with existing workflows while also reducing the number of clicks,” explained Mehta, who also serves as an assistant professor of gastroenterology at Penn.

Mitesh Patel, MD, co-lead author of the study and an associate professor of medicine at Penn, said that the EHR optimization helped alleviate clinician burden.

“Alert fatigue likely contributes to the high rates of clinician burnout in the US,” noted Patel, who also serves as vice president for clinical transformation at Ascension. “This simple intervention both improved clinician workflow and identified patients who can receive treatment for hepatitis C sooner than they might have had the system not been in place.”

The researchers said they hope to expand this system and are currently examining other clinical areas where these EHR nudges may have benefits.

“Our study shows that there are opportunities to leverage nudges in the electronic health record to improve health outcomes while maintaining physician autonomy,” Mehta concluded.