Workflow-embedded automation improves hepatitis B screening and safety in b/tsDMARD users

Area of Science:

• Rheumatology
• Hepatology
• Health Informatics

Background:

• Suboptimal adherence to hepatitis B virus (HBV) screening before initiating biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) increases reactivation risk.
• Guideline-mandated universal screening is not consistently followed, necessitating improved strategies.

Purpose of the Study:

• To evaluate the impact of a workflow-embedded clinical decision support system (CDSS) on HBV screening rates.
• To assess the effect of CDSS integration on HBV reactivation and hepatitis flares in patients starting b/tsDMARDs.

Main Methods:

• Retrospective study of 1,909 adults initiating b/tsDMARD therapy from 2004-2024.
• Comparison of three stages: baseline, education, and workflow-integrated CDSS.
• CDSS automatically verified HBV serologic status and generated orders for missing screenings.

Main Results:

• HBV screening completion, including the two- and three-marker panels, significantly increased with CDSS implementation (93% and 90% respectively).
• Hepatitis B virus reactivation (HBVr) rates decreased from 5.2% to 1.5%, and hepatitis flares decreased from 1.9% to 0.2%.
• Antiviral prophylaxis and HBV DNA monitoring remain underutilized.

Conclusions:

• Workflow-embedded CDSS achieved near-universal HBV screening, substantially reducing HBVr and flares.
• Future systems require enhanced long-term monitoring and stricter adherence to prophylactic guidelines to mitigate residual risk.