Electronic Health Records

Adoption & Implementation News

Minnesota Physician EHR Use to Target HIV Testing

By Kyle Murphy, PhD

Leading healthcare providers in Minnesota are seeking to leverage physician EHR use to improve HIV screening, according to Star-Tribune.

The support for the state's HIV screening rules is visible in its uptake by two leading healthcare organizations in the state, HealthPartners and the Mayo Clinic.

Glenn Howett reports that the former, a 28-clinic health system serving 400,000 patients, made key changes to its EHR technology in March 2015 that in turn makes use of clinical decision support to prompt physician EHR users to test patients for HIV. Mayo is set to switch its health IT systems to Epic, a decision it announced earlier this year, but is still well advanced in EHR adoption and use with a hybrid configuration of health IT infrastructure:

Using prompts in the electronic health record, HIV testing rates for patients at the system’s clinics increased from 25 percent in 2010 to 56 percent in 2012 for men, while the rate for women increased from 40.5 percent to 66 percent. Women typically have higher testing rates because most pregnant women routinely receive an HIV test.

The initiative to expand HIV screening was put into place at the direction of the Minnesota-based Institute for Clinical Systems Improvement (ICIT), a non-profit organization with the goal of achieving the triple aim. Its guidance follows that of the United State Preventive Services Task Force, which updated its recommendation for HIV screening in 2013:

Using prompts in the electronic health record, HIV testing rates for patients at the system’s clinics increased from 25 percent in 2010 to 56 percent in 2012 for men, while the rate for women increased from 40.5 percent to 66 percent. Women typically have higher testing rates because most pregnant women routinely receive an HIV test.

The ICIT's strong recommendation calls on providers to screen all patients between the ages of 15 and 64 at least once.

"The evidence for both reducing transmission and reducing AIDS events and deaths with early treatment is largely based on fair-quality observational studies," the guidance states. "The consistency of results among the observational studies, combined with the results of three randomized control trials (one on reducing transmission and two on reducing AIDS and death risk with early treatment), increases confidence in their results."

The successful implementation of the EHR workflow should be easily reproduced in other care settings throughout Minnesota, given the state's mandate for providers to adopt interoperable EHR technology by the beginning of 2015. Additional, Minnesota providers are also required to connect to a state government-approved health information organization.

A recent bill, however, went into effect in May 2015 that exempted solo practitioners from having to abide by the mandate. Thanks to state lawmakers, a Minnesota Department of Human Services policy omnibus bill no longer requires small medical practices, particularly solo practitioners, to invest in EHR implementation.

The mandate raised questions about protect health information and the confidentiality of sensitive health data for patient privacy advocates.

An informal survey conducted at the end of 2014 found that mental healthcare providers in the state were concerned about the confidentiality of their treatment records if every provider in the state had some sort of access to patient health information, but answers to other questions about EHR adoption showed confusion and a lack of clarity over the cost of EHR systems and how much effort will be required to adopt and use them.

Whatever the pushback against EHR adoption and physician EHR use, HIV testing rates have already increased and with it early detection of a dangerous communicable disease.

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