Do Electronic Health Record Reminders Increase Screening for Sexually Transmitted Diseases?

BACKGROUND:  American Indian/Alaska Native (AI/AN) communities have disproportionately experienced high rates of Sexually Transmitted Diseases (STD). The US Preventive Services Task Force recommends that all sexually active women between 16-25 years of age are screened for chlamydia. The Indian Health Service (IHS) data demonstrate that in 2014 35% of AI/AN women between 16-25 years of age were screened for chlamydia. To increase Chlamydia screening among AI/AN by assisting healthcare providers identify individuals at higher risk for STD infection, a rural IHS hospital incorporated Electronic Health Record (EHR) clinical reminders.  Our goal was to determine the utility of these reminders and identify additional methods to improve Chlamydia screening rates.

METHODS:  We queried a hospital’s EHR system to compare chlamydia screening rates among AI/AN before and after reminders were implemented at a rural IHS hospital. We compared results among clinical departments within the hospital and performed an in-person consultation and outreach to healthcare providers in different departments to understand barriers.

RESULTS:  Overall chlamydia screening rates remained similar before and after the incorporation of EHR reminders; screening rates varied among clinical departments (range: 4–77%). The highest screening rates were observed in the Obstetrics and Gynecology department (77%) and the lowest in the Emergency Medicine (4%), Pediatrics (6%) and Urgent Care (15%). Increased screening after instituting reminders was observed in Family Medicine, Pediatrics, Urgent Care and Internal Medicine. A small decline was observed in the Obstetrics and Gynecology department. The largest percent increase among departments occurred in Internal Medicine with 12% and 34% individuals screened before and after instituting reminders, respectively. Among 75 providers interviewed, 56% (42/75) reported screening 0–25% of their patients and only 13% (10/75) screened more than 75% of their patients. Results of the outreach effort identified confusion and difficulties adhering to laboratory protocols for urinalysis, lack of standing orders and cost of screening as potential barriers.  Recommendations for improvement included standing orders for screening and automation of lab protocols. Healthcare providers recommended community outreach and education to increase STD screening rates.

CONCLUSIONS:  EHR reminders can be a useful tool to improve STD screening rates.  Active outreach to clinical care areas in hospitals and clinics, preferably by a local champion, can further enhance STD screening.   STD screening in the Emergency, urgent care, and pediatric department settings is limited and presents a missed opportunity.