How the University of Maryland Medical System Used its EHR to Improve HIV/HCV Care

There is no better time for the health IT community to come together under one umbrella to raise national awareness of the benefits information technology can bring to the US health system. National Health IT (NHIT) Week is a nationwide awareness week focused on the value of health IT. Each year, NHIT Week Partners educate industry and policy stakeholders on the value of health IT for the US healthcare system. Every Tuesday leading up to NHIT Week, our valued partners will share their voice and experience on how they demonstrate the value of health IT.

At its heart, health IT is about improving the lives of patients and their families. When an electronic health record (EHR) works well, it makes information more accessible, mistakes less frequent, and healthy living easier. As a healthcare consulting firm, we know health IT can transform care and drive better outcomes.

However, when budgets and user dissatisfaction are clamoring for attention, patient impact isn’t always the first thing on our minds. When stress levels are high, it can be hard to remember that our work - the meetings, the hours of build, the late nights on go-live – is paying off to improve patient care.

That’s why, during 2017 National Health IT Week, we’re pleased to reflect on a project that embodies the impact of EHRs on patient lives. After all, we believe that health IT – and the experience we’re about to share – is worth celebrating.

The challenge

Last year, Nordic had the privilege of working with The University of Maryland Medical System (UMMS) to answer a common question: How do you use your EHR to improve population health without creating more work for providers?

At UMMS, the focus of this question was HIV and Hepatitis C Virus screening and linkage to care.

UMMS wanted to increase the effectiveness of HIV and HCV screenings in the inpatient, emergency department (ED), and ambulatory settings, while minimizing impact on providers. The ED was a common target for EHR initiatives, and leadership knew that compliance would be challenging if introducing another project.

“HIV and HCV screenings are crucial to patients’ health,” said Dr. Dan Lemkin, UMMS director of clinical informatics. “From improving outcomes to reducing utilization, there are many good reasons to do a project like this. However, the operational reality suggests a lot of scope creep here. You’re asking providers to take time out to engage a specific issue.”

To address this challenge, The JACQUES Initiative of the Institute of Human Virology at the University of Maryland School of Medicine – a program aimed at improving access and engagement in HIV/HCV care – created the idea to build EHR functionality to automate patient identification and provider notification.

By automating these processes, the team believed they could increase screening rates without increasing workload, helping to improve the health of a vulnerable population.

For example, more than half of people living with HIV and HCV are not in care. To automate HIV/HCV screening processes, The JACQUES Initiative’s Executive Director Jamie Mignano submitted a grant to fund the project and collaborated with Dr. Lemkin’s team.

The results

Introducing several functionalities to UMMS’s EHR, the optimized system now

• identifies patients based on screening need,

• automates orders for patients who meet criteria,

• recommends follow-ups to providers, 

• offers an at-a-glance view of patient status,

• alerts the care team of previous positives, and

• helps with follow-ups and prevention to incorporate patient education and resource information into the after-visit summary.

“We’ve successfully recorded 100 new HIV diagnoses at our two hospitals,” Mignano said, “and about 80 percent of those folks have followed up with getting care. For HCV, almost 20 percent of the 7,000 persons screened have a positive antibody test and required further testing and linkage to care.”

The work has been critical to improving intervention for HIV/HCV patients and funneling patients from the acute care center into an ambulatory setting, explained both Dr. Lemkin and Mignano. With quick identification, triage and follow-up for HIV/HCV patients, they are more likely to receive the care they need.

“These automated programs, where we can leverage technology to mitigate the impact on providers while improving population health, are crucial,” said Dr. Lemkin.