Background: The Centers for Disease Control and Prevention (CDC) estimates over 1.2 million Americans are living with HIV (human immunodeficiency virus). Of those, approximately 14% are unaware of their HIV-positive status. In 2014, most hospitals adopted some form of Electronic Health Records (EHR) and one year later, the Centers for Medicare & Medicaid Services extended Medicare coverage for annual HIV screenings. Despite these developments, there has been limited progress in expanding HIV testing in inpatient settings.

Purpose: The present study was conducted at Jersey City Medical Center (JCMC) in an effort to expand HIV testing in an inpatient setting by implementing EHR modification in the form of testing prompts.

Description: This study began on January 1st 2016 at JCMC, a teaching hospital that utilized Soarian as its main EHR system. All lab work orders were placed through this EHR system, which allowed attending physicians to manually select which tests to order for each patient. The number of daily orders for HIV screenings was recorded for 145 consecutive days before EHR modification (n=145) to establish baseline data.

EHR modification occurred on the 146th day of the study (May 25th, 2016). This modification featured testing prompts displaying CDC guidelines for screening eligible patients over the age of 18 for HIV. These prompts activated each time a physician ordered lab work for patients who were admitted to the inpatient floors. EHR modification was completed within 24 hours. Orders for HIV screenings on this transitional date were excluded from analysis, as it did not conform to either conditions of the study (before EHR modification and after EHR modification).

After EHR modification was completed, the number of daily orders for HIV screenings was recorded for an additional 145 consecutive days (n=145) for comparison. Testing data was available for all 145 consecutive days before and 145 consecutive days after EHR modification, without any incidence of downtime in regards to ordering lab work. Furthermore, any tests for the same patient in the same month were removed from daily testing data.

Since the beginning of this study – before testing prompts were implemented – JCMC inpatient units ordered approximately 8.53 (SD=3.25) HIV screenings per day.  The average number of daily orders for HIV screenings increased twofold after EHR modification (M=17.39, SD=4.26), t(288) = 19.90, p < .001. By the end of this study, JCMC identified 86 HIV-positive and linked over 90% of these patients to care.

Conclusions: Conventional HIV screening methods in the inpatient setting might not be sufficient at detecting most HIV-positive cases, since some patients are not forthcoming with information regarding risk factors and sexual history. By implementing testing prompts in its EHR system to encourage increased testing for HIV, Jersey City Medical Center was able to increase the number of individuals aware of their HIV status and link them to care as needed. The EHR modification is still being used today and is regularly reviewed for quality improvement.