Automated Opt-Out Hepatitis C Testing to Reduce Missed Screening Opportunities in the Emergency Department

Previously, the BMC ED team collaborated with in-hospital laboratory partners to move reflex testing in house and decrease time to result delivery. Concurrently, we implemented in our electronic health record (EHR) a bestpractice advisory (BPA) that recommends providers to order opt-in HCV laboratory tests for patients having other laboratory tests ordered and meeting HCV screening criteria6 In accordance with US Preventive Services Task Force and Centers for Disease Control and Prevention screening guidelines, the BPA was activated for patients with no previous HCV antibody (Ab) test in the EHR for once-lifetime screening for all patients and every six months for patients at increased risk for HCV.7,8 Patients with increased risk for HCV were defined as those who had documented substance use disorder in their problem list within the EHR. In addition to those participating in the implementation, we also worked closely with our program's data manager, HCV patient navigators, and HCV pharmacists to ensure all HCV testing would be captured and newly identified HCV-positive patients would receive follow-up, connected to appropriate care and treatment. Institutions implementing or activating a similar screening model in the ED should make sure they also dedicate appropriate resources to connecting patients to care and treatment, because recent Centers for Disease Control and Prevention reports show that there are major gaps in treatment, with only one in six patients with Medicaid and one in three with commercial insurance achieving viral clearance 9 SUSTAINABILITY Our intervention is very sustainable because, once implemented, the HCV optout screening system will continue to work automatically without any further intervention from providers.