HIV remains a public health risk, with a high rate of transmission by people unaware they are infected with the virus. Although in New York State it has become law to offer testing at every point of entry in the health care system, we are still not achieving compliance with our test offers across the state. Despite efforts to achieve 100% compliance at our institution, achieving the target was difficult because of lack of coordination and paper chart documentation. With the implementation of the electronic medical record (EMR), we set out to utilize this opportunity to achieve higher compliance with the offer of an HIV test and assess overall impact.
(1) To increase the compliance rate of the offer of an HIV test to all inpatients; (2) to assess the correlation of EMR uptake by providers with the likelihood of test offering and the ability to track the result of offer; (3) to assess if increased offers led to increased case finding.
In 2010, educational lectures, communication with providers, and modification of paper history and physical (H&P) forms were completed to include the offer of an HIV test to patients admitted to hospital. A patient educator rounded on the medical wards offering support for rapid HIV testing. This yielded increased awareness and testing; however, compliance remained difficult to assess. In 2012, the EMR was introduced on the medical wards and rolled out electively to house staff and hospitalists. Strategically, we programmed a “hard stop,” or mandatory offering of HIV testing in the electronic admission process. Six medical units were evaluated over a month in an urban academic medical center in New York City. Eligibility criteria for test offering by provider included patients ≤ 65 years, not known to be HIV+, and alert and oriented with the ability to give consent. Of the 448 patients eligible for testing in the 4‐week period, 372 patients were offered testing, equaling 83% compliance with NYS law. Units had a varying degree of uptake of the electronic chart ranging from 34% to 98%. The unit with the lowest rate of uptake of EMR (31%) had the lowest rate of compliance with test offering, at 65%. The team with a higher rate of compliance with electronic H&P (88%) had the highest compliance rate with test offering, at 97%. Among the 372 patients who were offered testing, 93 patients accepted testing (25%). Of those who accepted testing, 4 were newly identified as HIV positive (overall 4.3% HIV positivity rate among total tested). This was increased from the 2010 pilot, in which we detected a 2% HIV‐positive rate prior to initiation of electronic record.
Electronic medical records with an embedded hard stop for HIV test offer can help institutions increase compliance with test offering in this important public health issue. By increasing test offering, we saw an increase in patient acceptance of actual tests done and a higher rate of positive results. Further evaluation should be done to see if this correlation persists.