Streamlining linkage to treatment and prevention utilizing automated EMR algorithms
Abstract
The CARE Initiative (CI) provides routine, annual opt-out HIV screening for ED patients who meet national eligibility guidelines. CI utilized a computer based EMR algorithm to recognize new HIV positive individuals who received care in the ED. Following the success of the initial algorithm, CI optimized the algorithm to include previously diagnosed HIV patients and high risk negative patients (HRN).
Proposal Summary
The CARE Initiative (CI) is an opt-out HIV and Hepatitis C (HCV) testing program based in the Memorial Health University Medical Center (MHUMC) Emergency Department (ED). MHUMC provides care for 35 counties in the region, and the ED supports over 100,000 annual patient visits. As the safety net hospital for the region, MHUMC serves both urban and rural populations. Utilizing an automated EMR algorithm for the early detection of new positives and the re-engagement of known positives streamlines the linkage to care process and allows patients to be engaged in HIV treatment faster. CI screening methods include an automated EMR algorithm designed to identify new and known HIV positive individuals. The electronic medical record alerts the CI staff with an inbasket message when there is a confirmed positive HIV lab result entered into the patient’s chart, or a nurse documents patient disclosed HIV status at triage. Additionally, CI staff receive notifications if a patient with a documented history of HIV or previous positive lab result is triaged in the ED. Upon receipt of the in basket notification, the linkage specialist determines if the patient is new, known, in care, or out of care. Linkage specialists perform notification appointments with new HIV patients and link both new and known patients to HIV care in the community. Both early detection of new positives and re-engaging known positives in anti-retroviral treatment reduces the burden of the disease on the community. Since the program inception in 2016, we have identified 158 positive patients. Approximately 51% (80) were newly diagnosed and 48% (76) were previously known positives that received a HIV test. 86% (80) of new positives have been linked to care and treatment in the community. The EMR algorithm identified 604 known positives, and of this number 81% (489) were already in care. Nine percent (57) of the known positives were out of care and 75% (43) were linked to care. Patients who were deceased, terminally ill, or incarcerated were not eligible for linkage. PrEP referrals were based on patient preference and 100% of interested PrEP patients were linked to care in the community.
Relevance And Significance
Patients who are engaged in treatment reduce the community viral load and, consequently, the burden of the disease in communities. Automated EMR algorithms and alerts help to improve access, retention, and linkage to care and to ensure that all HIV infected persons are given the opportunity to be engaged in care.
Session Format
Presentation Session
Keywords
access to care, linkage, HIV, emergency department
Location
Savannah, Ga.
Publication Type and Release Option
Presentation (Open Access)
Recommended Citation
O'Ree, MariAnna and Wiggins, Jean, "Streamlining linkage to treatment and prevention utilizing automated EMR algorithms" (2019). 9th Annual Rural HIV Research and Training Conference (2014-2019). 3.
https://digitalcommons.georgiasouthern.edu/ruralhiv/2019/2019/3
Streamlining linkage to treatment and prevention utilizing automated EMR algorithms
Savannah, Ga.
The CARE Initiative (CI) provides routine, annual opt-out HIV screening for ED patients who meet national eligibility guidelines. CI utilized a computer based EMR algorithm to recognize new HIV positive individuals who received care in the ED. Following the success of the initial algorithm, CI optimized the algorithm to include previously diagnosed HIV patients and high risk negative patients (HRN).
