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Implementing Indicator Condition-Guided HIV Screening Alerts in the Emergency Department: Lessons Learned from a Case
Francisco Fanjul1,2,3, Maria Dolores Macià Romero2,3,4, Pablo Fraile2,4
1Infectious Diseases Unit, Son Espases University Hospital, Palma, Spain.
Summary
Electronic health record alerts improve HIV screening in emergency departments. Uptake varied by clinical service, not patient age, highlighting the importance of workflow integration for digital health tools.
Area of Science:
- Public Health
- Health Informatics
- Infectious Disease Epidemiology
Background:
- Indicator condition (IC)-guided HIV testing is a recommended, cost-effective strategy for HIV screening.
- Implementation of IC-guided HIV testing is inconsistent, particularly within emergency departments (EDs).
- Electronic health record (EHR) alerts show potential to improve adherence to HIV testing protocols.
Purpose of the Study:
- To evaluate the real-world uptake of a non-interruptive EHR alert system for IC-guided HIV screening in an ED setting.
- To identify determinants of alert acceptance, including patient age, clinical service, and time of day.
- To assess the impact of EHR alert implementation on HIV case detection.
Main Methods:
- Prospective case study design from August 2023 to April 2025.
- A non-interruptive EHR alert was triggered by specific laboratory orders and prescriptions, firing only if HIV serology was not already ordered.
- Acceptance patterns were analyzed using descriptive stratification to control for confounding variables such as patient age and clinical service volume.
Main Results:
- Out of 3,240 alert activations, 523 (16.1%) were accepted, leading to 398 completed HIV tests.
- Eight patients tested positive for HIV (2.01%), with four cases being actionable (1.01%).
- Apparent lower uptake in younger patients was confounded by a high concentration of alerts in gynecology/obstetrics; acceptance was higher across all age groups outside this specialty.
Conclusions:
- Observed age-related differences in EHR alert uptake for HIV testing were primarily due to clinical service distribution, not intrinsic clinician bias.
- Specialty culture, workflow integration, and clear ownership of preventive tasks are critical for successful adoption of digital health alerts in EDs.
- This study underscores the need for tailored implementation strategies to optimize HIV screening in emergency care settings.
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