Improving rates of HIV testing in emergency departments in a health system using clinical decision support

Sexually transmitted infections (STIs) remain a public health priority. The Centers for Disease Control (CDC) recommends comprehensive screening for STIs and HIV, defined as testing for gonorrhoea/chlamydia (GC-CT), syphilis and HIV in persons undergoing STI evaluation. Many patients utilize emergency departments (EDs) for STI evaluation; however, HIV co-testing rates remain low. Electronic Health Record (EHR)-based clinical decision support (CDS) can help providers implement best practices. We assessed the impact of two CDS tools on HIV co-testing rates with GC-CT in freestanding EDs (FSEDs) of a statewide health system.

CDS Interventions included Comprehensive STI Order Set made available 1/2024 and a Comprehensive STI Pathway made available 1/2025. We included FSED encounters for adult patients with GC-CT NAAT 1/1/2022-11/21/2025 and measured HIV co-testing rates. Process measures included overall CDS utilization by FSED type (urban Denver sites, Metro; outlying Colorado sites, Outlying; aggregated sites, All Sites). Analysis included statistical process control charts and descriptive statistics.

GC-CT testing occurred in 11 087 patient encounters between 1/1/2022 and 11/21/2025. HIV co-testing rates averaged 2.6% 2 years before the intervention (2022-2023). After the first intervention (2024), HIV co-testing rose to 13.1%, with a positive shift in SPC charts across All Sites, Metro and Outlying. After the second intervention (2025), HIV co-testing rose to 18.3%, with greater impacts at Metro FSEDs; positive shifts in SPC charts were seen across All Sites and Metro but not Outlying EDs.

EHR-based CDS was effective for increasing HIV co-testing in freestanding EDs.