JMIR Publications

ABSTRACT

Background:

The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfil this need and improve adherence to CDC treatment and screening guidelines for gonorrhea, HIV, and PrEP.

Objective:

The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea, and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea, as an EHR-based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic.

Methods:

We developed four tools for this CDS intervention: a form for capturing sexual history information (‘SmartForm’), rule-based alerts (‘Best Practice Advisory’; BPA), an enhanced STI order set (‘SmartSet’), and a documentation template (‘SmartText’). A mixed-methods, pre-post design was used to measure the feasibility, acceptance, and usefulness of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name ‘X-Clinic’. We measured the utilization of the CDS solution within our target population of patients who had either a confirmed gonococcal infection, or an STI-related chief complaint. We conducted four mid-point surveys and three key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. Findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods.

Results:

Within the X-Clinic, the CDS alerted clinicians (as a BPA) in one-tenth (348/3,451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300; 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%) and the odds of ordering these tests were eleven times higher in these patient encounters (OR:11.28, CI:8.86-14.38) compared to those encounters where CDS did not alert clinicians (302/3,103, 9.73%).

Conclusions:

We successfully built and implemented multiple CDC treatment and screening guidelines into a single, cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of utilization. Clinical Trial: Not applicable