Challenges of an EMR-Based Hospital Alert Program for Micro-Elimination of Hepatitis C in Tertiary Referral Hospitals

Despite advances in hepatitis C virus (HCV) treatments, diagnostic gaps and linkage-to-care hinder elimination efforts. We evaluated an electronic medical record (EMR)-based automated alert system to improve HCV care at tertiary referral centers. We have screened 1,303,578 patients who were tested for anti-HCV, and analyzed 8291 patients positive for anti-HCV antibody (Ab) across four tertiary hospitals between July 2009 and December 2023. The EMR alert system, implemented in June 2021, identified patients with positive anti-HCV antibody results who had not undergone HCV ribonucleic acid (RNA) testing. We compared HCV RNA testing rates, linkage-to-care and time intervals between testing before and after system implementation. The HCV RNA test prescription rate increased from 60.5% in the pre-alert period to 66.9% in the post-alert period. In non-hepatology departments, the prescription rate increased from 47.1% to 60.5%. The interval between HCV Ab positivity to HCV RNA test prescription in patients without initial HCV RNA order decreased significantly from 1208.9 to 244.5 days. Among 732 previously HCV RNA untested patients who were followed up after alert implementation, 43.4% received HCV RNA testing, leading to 62 new HCV diagnoses. The referral rate to hepatology departments remained stable (83.3% pre-alert vs. 80.9% post-alert). In conclusion, implementation of an EMR-based alert system effectively improved HCV diagnostic rates and reduced testing delays, particularly in non-hepatology departments. This system represents a promising strategy for hospital-based HCV micro-elimination, but additional interventions might be needed to achieve optimal testing rates and linkage-to-care.