How a small hospital is overcoming the hidden challenges of EHR - PowerPoint PPT Presentation

How a small hospital is overcoming the hidden challenges of EHR alerts and RNA reflex testing implementation: A presentation from Kingsbrook Jewish Medical Center Neil Allen Pasco MD

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 Initial Patient KJMC ED  KJMC Acute Care Hospital Admission Engagement  KJMC Ambu Clinic /PT Family Health Center • Testing Criteria • Between the ages fo 13-64 years old. EHR • Last test >6 months. Registration • Pre-Test Info Waiting Area • Forced prompt within EMR to document patient's Triage refusal or acceptance of the HIV test. RN Blood Draw MD Lab

Hepatitis C Screening Q4 2015 400 378 Date Partnership was awarded 350 Date EMR modification was created 300 250 213 199 200 165 150 125 109 101 96 93 100 89 74 70 60 60 56 53 50 47 46 42 42 41 40 50 33 32 30 28 27 25 22 21 19 14 13 13 10 10 8 7 7 5 5 3 2 0 0 1 1 0 09/2015 09/2015 09/2015 10/2015 10/2015 10/2015 11/2015 11/2015 11/2015 12/2015 12/2015 12/2015 174A- 174B- 174C- 174A- 174B- 174C- 174A- 174B- 174C- 174A- 174B- 174C- Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Kingsbrook: Emergency Inpatient Outpatient Emergency Inpatient Outpatient Emergency Inpatient Outpatient Emergency Inpatient Outpatient Department Department Department Department Number Eligible for HCV Testing Based on Local Criteria Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab Number HCV Ab Positives Linear (Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab) Linear (Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab ) Linear (Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab )

HCV Ab Screening Q1 2016 200 180 175 160 140 132 130 129 126 122 120 110 102 100 87 78 80 58 60 55 50 48 42 39 40 35 32 29 26 20 16 16 20 14 14 11 10 9 9 8 7 6 4 2 1 1 0 01/2016 01/2016 01/2016 02/2016 02/2016 02/2016 03/2016 03/2016 03/2016 04/2014 04/2014 04/2014 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: Emergency Outpatient Inpatient Emergency Outpatient Inpatient Emergency Outpatient Inpatient Emergency Outpatient Inpatient Department Department Department Department Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab Number HCV Ab Positives

Testing Penetration in Outpatient Setting 4000 3500 3000 2500 2000 1500 1000 500 0 01/2016 02/2016 03/2016 04/2014 174C- Kingsbrook: Outpatient 174C- Kingsbrook: Outpatient 174C- Kingsbrook: Outpatient 174C- Kingsbrook: Outpatient Total Tests Performed Individual Patients Seen

HCV Ab Positive and Reflex Testing 18 16 14 Where is the Reflex Testing? 12 10 8 6 4 2 0 01/2016 01/2016 01/2016 02/2016 02/2016 02/2016 03/2016 03/2016 03/2016 04/2014 04/2014 04/2014 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: 174A- Kingsbrook: 174C- Kingsbrook: 174B- Kingsbrook: Emergency Outpatient Inpatient Emergency Outpatient Inpatient Emergency Outpatient Inpatient Emergency Outpatient Inpatient Department Department Department Department Number HCV Ab Positives Number HCV RNA Positive Number of HCV RNA Negatives Number of HCV RNA Invalid/ Number of Individuals Testing HCV RNA Positive Linked to Care Indeterminate/ Tests that Did Not Yield a Result

Multidisciplinary RCA revealed several issues: Lab orders not properly placed in ED setting Difficulties in off site RNA reflex testing Nursing/Tech Education on which tubes to use

Hepatitis C Cumulative Data through April, September, 2015 - December, 2016 September, 2015 - March, 2016 April, 2016 2016 HCV Ab Tests Performed 2,559 356 2,915 HCV Ab Positive Patients Identified 167 9 176 Through Testing HCV Ab Seropositivity 6.5% 2.5% 6% HCV RNA Tests Performed 112 9 121 HCV RNA Positive Patients 52 3 55 Identified Through Testing HCV RNA Positive Patients (identified through testing) 34 3 37 Attended First Appointment