Unintended adverse consequences of electronic health record introduction to a mature universal HIV screening program
Bibliographic Data
| ID | 19444229 |
|---|---|
| Authors | Laura N Medford-Davis, Laura N Medford‐Davis (0000-0003-4127-4297, University of Pennsylvania, corresponding author), Katharine Yang (0000-0002-8209-1289, Baylor College of Medicine), Siavash Pasalar (0000-0002-9683-3722, Harris Health System), M Tyson Pillow (0000-0001-7584-5452, Harris Health System), Nancy Miertschin (Harris Health System), Nancy P Miertschin, William F Peacock, W Franklin Peacock (Baylor College of Medicine), Thomas P Giordano (0000-0002-9346-5530, Baylor College of Medicine), Shkelzen Hoxhaj |
| Year | 2016 |
| Volume | 28 |
| Issue | 5 |
| Pages | 566-573 |
| Publication date | 2016-05-03 |
| Open Access | No |
| Type | ARTICLE |
| Venue | AIDS Care (JOURNAL) |
| Journal identifiers | ISSN: 0954-0121 • E-ISSN: 1360-0451 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/09540121.2015.1127319 |
| PMID | 26729258 |
| OpenAlex | W2225965119 |
| Language | EN |
| References cited | 31 |
Early HIV detection and treatment decreases morbidity and mortality and reduces high-risk behaviors. Many Emergency Departments (EDs) have HIV screening programs as recommended by the Centers for Disease Control and Prevention. Recent federal legislation includes incentives for electronic health record (EHR) adoption. Our objective was to analyze the impact of conversion to EHR on a mature ED-based HIV screening program. A retrospective pre- and post-EHR implementation cohort study was conducted in a large urban, academic ED. Medical records were reviewed for HIV screening rates from August 2008 through October 2013. On 1 November 2010, a comprehensive EHR system was implemented throughout the hospital. Before EHR implementation, labs were requested by providers by paper orders with HIV-1/2 automatically pre-selected on every form. This universal ordering protocol was not duplicated in the new EHR; rather it required a provider to manually enter the order. Using a chi-squared test, we compared HIV testing in the 6 months before and after EHR implementation; 55,054 patients presented before, and 50,576 after EHR implementation. Age, sex, race, acuity of presenting condition, and HIV seropositivity rates were similar pre- and post-EHR, and there were no major patient or provider changes during this period. Average HIV testing rate was 37.7% of all ED patients pre-, and 22.3% post-EHR, a 41% decline (p < 0.0001), leading to 167 missed new diagnoses after EHR. The rate of HIV screening in the ED decreased after EHR implementation, and could have been improved with more thoughtful inclusion of existing human processes in its design
Cohort · Electronic health record · Electronic medical record · Emergency department · Family medicine · Health care · Health records · Incentive · Medical emergency · Medical record · Retrospective cohort study · Adolescent Sexual and Reproductive Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Emergency Medicine · Internal Medicine
| Highly cited | No |
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