The use of a computer reminder system in an emergency department universal HIV screening program

We describe electronic medical record use in automated eligibility determination for an emergency department (ED)-based nontargeted HIV screening program.

We reviewed the electronic medical record system at an urban, inner-city ED from March 17 to April 14, 2008. During that period, patient eligibility for HIV screening was electronically determined according to preprogrammed criteria: (1) age between 18 and 64 years; (2) no known history of HIV disease; and (3) no known HIV screening in the previous year. This populated an electronic work list used by HIV testing counselors.

Of 8,489 ED patients during the study period, the electronic medical record system determined 5,794 (68.3%) as eligible. Of 1,484 (25.6%) patients approached for screening, 1,121 (75.5%) consented, and 5 received confirmed positive results (0.4%). Reasons for ineligibility, as determined by the electronic medical record system, were previous screening 1,125 (41.7%), age 890 (33.0%), known HIV 111 (4.1%), and reason unknown 569 (21.1%).

Clinical informatics solutions can provide automated delineation of ED subpopulations eligible for HIV screening, according to predetermined criteria, which could increase program efficiency and might accelerate integration of HIV screening into clinical practice.