CDS alert increases screening of hepatitis C in at-risk populations

Adding a clinical decision support (CDS) tool to remind providers to screen for hepatitis C virus (HCV) greatly increases the practice in American Indian/Alaska Native populations, according to two studies in the Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Approximately 3.5 million people living in the United States have HCV, resulting in 20,000 deaths a year, according to the first report, about the Cherokee Nation. American Indian/Alaska Native populations have the highest incidence of such infections. New drugs were released several years ago to combat the disease, causing the CDC to recommend one-time testing of people born between 1945-1965 who are at higher risk of the disease, in addition to those at greater risk for other reasons.

In the first study, the Cherokee National Health Services implemented a tribal testing policy, adding a CDS reminder to its electronic health record system and educating primary care physicians about it. In the next 33 months, the number of people who received the screening for the first time increased from 3.6 percent (3,337 people) to 18.2 percent (16,772 people).

The screening found 715 people who tested positive for HCV antibodies, 68.3 percent received confirmatory testing and 79.5 percent of those had chronic HCV infection. Thirty-two percent of them also had advanced liver disease and needed immediate treatment.   

The second study focused on testing of American Indian/Alaska Natives who receive care through the Indian Health Service. The IHS implemented a program to increase testing of those born between 1945-1965 because of their higher risk of HCV.

The program included recommendations to the 85 percent of IHS facilities that used EHRs to add a CDS alert, as well as increased telehealth, education and other initiatives. Testing overall increased from 7.9 percent to 32.5 percent; local facilities that added a CDS alert had higher testing rates, suggested that the tools "substantially contributed" to those rates.  

To learn more:
- read the Cherokee Nation study
- here's the Indian Health Service study