METHODS: In August 2014, PHSKC received a 4-year CDC grant to collaborate with the University of Washington, healthcare and community HCV support organizations (HCO) to improve HCV testing, treatment and cure. Year 1 activities included offering training to healthcare providers on HCV diagnosis, evaluation, and treatment through Project ECHO (Extension of Community Healthcare Outcomes); utilizing HCV case management; developing enhancements to optimize use of EHR systems; strengthening public health surveillance; and enhancing integration of clinical and public health data systems.
RESULTS: Five HCOs began electronically submitting HCV-related lab and clinical data to PHSKC; one HCV support organization submitted case management data through a separate mechanism. PHSKC data systems were reconfigured to capture electronic lab and clinic data. Reports were created for providers to track patients along the HCV care continuum. Lessons learned: (1) initial budgets and timelines underestimated the time and resources needed to extract data from diverse EHR systems and to modify the surveillance database; (2) HCOs faced barriers adapting their EHR systems to extract and report data on HCV treatment and care both internally and to public health (3) adopting HCV reflex RNA testing is challenging for many labs and is a barrier for uninsured patients; (4) some primary care providers are unconvinced of the rationale for and cost-effectiveness of birth cohort screening; (5) restrictions on access to antiviral drugs for HCV treatment and onerous insurance approval processes are barriers to successful HCV management; (6) patients benefit from strong community advocates to help negotiate treatment barriers.
CONCLUSIONS: Despite the above limitations, this project demonstrated substantial progress in a year’s time towards building an improved and sustainable public health and community-based health care program targeting HCV.