Background:
1.2 million people in the United States are living with an HIV infection and one in five is unaware of their infection. In Chicago, there are currently over 20,000 people living with HIV/AIDS and estimated that more than 5,000 people in Chicago are HIV–positive but not yet aware of their infection. In order to improve HIV care and prevention measures, the University of Chicago Hospitals has implemented a hospital–wide actionable reminder (electronic reminders linked to computerized order entry) that facilitates direct ordering of HIV tests through verbal consent.
Purpose:
Our goal is to determine whether the HIV actionable reminder is an effective method to increase the number of HIV tests performed by clinicians in the hospital in order to improve HIV prevention measures.
Description:
In accordance with CDC guidelines set in 2006 to transition to verbal consent for HIV testing, a grant was given by the Chicago Department of Public Health to increase testing for disproportionately affected populations in Chicago. As a result, the actionable reminder for HIV testing was approved and implemented in November 2011. A successful reminder system includes proper integration of the reminder into clinician workflow and the ability to easily facilitate the recommended action. The HIV alert was created to fire in all hospital departments excluding Anesthesiology and Critical Care. These two departments were left out as patients within these departments are not in a stable condition to approve testing. The parameters for the reminder were set to fire for all patients admitted between ages 13––64 who do not have record of receiving an HIV test in the past 12 months. If patients were classified as high–risk (share needles or have unprotected sex), the alert fired to repeat testing every 6 months. Education was given to each department explaining how the HIV alert works and the importance of the clinician to proactively recommend that patients should receive the test. In addition to the alert and electronic order, the physician is able to document consent in the EMR, print necessary HIV testing information for the patient, and obtain a weekly report to ensure active case follow up for all positive test results.
Conclusions:
Preliminary results suggest that the alert is effectively increasing the number of tests within the hospital. In the past 6 months prior to reminder implementation, the hospital averaged 135.25 tests per week. The data shows this number has now risen to 152.5 tests per week with the alert. Data will be collected for the following 6 months to determine the amount of impact the HIV alert has made. Education sessions are being conducted routinely along with feedback on number totals for each department to reinforce testing by clinicians. Also, revisions are periodically being made on the alert to make it more robust in firing. Thus far, the HIV alert is proving to be an effective way to increase HIV prevention measures.