Strategies for Increasing HIV Screening Rates

Health centers are always searching for innovative strategies to increase their HIV screening rates. This year, health centers have gotten creative by combining HIV testing with COVID-19 screening, while others are mailing at-home HIV testing kits to patients. Finding strategies to help increase HIV screening at your health center is a lesson in trial and error. We hope our latest blog will give you some ideas on improving your HIV screening rates!

Population Health Strategies

Discussions with health centers who have had success with increased screening rates showed that using population health tools such as registries or huddle sheets is more effective than point of care alerts. Using population health tools can help strengthen your health center’s ability to identify patients in need of HIV screening. A few quick and easy strategies include:

• Getting trained on your population health functionalities in your EHR or health IT systems. Identify training opportunities on population health management tools from your EHR vendor or other health IT tools. Use what you learn in training to assess and track HIV screening rates across the patient population. Generate comprehensive dashboards and reports using population health-specific tools like i2i, Azara Data Reporting and Visualization System (DRVS), or Tableau to identify gaps in screening. Consider adding HIV to your huddle sheets.
• Being creative with your population health management tools. Using your population management tools to identify patients in need of screening is half of the equation. The other half is integrating these dashboards, reports, or huddle sheets into care processes. Think beyond just the provider visits. Nurses or health educators may reach out or have the conversation with the patient. Population health managers may include HIV screening with other care gap outreach. 
• Working with care teams to determine how to address gaps in HIV screening. Examples include new workflows, regular monitoring at provider meetings, incentives, or contests (or some combination of these).

Using population health approaches allows the health center to have better insight into areas for improvement, be more proactive, and make the best use of standing orders and pre-visit planning. 

Standing Orders and Pre-Visit Planning

Incorporating standing order sets into your EHR can be a passive yet effective strategy for increasing HIV screening at your health care center. HIV screenings can be included in pre-built order sets in the EHR for annual wellness visits for adults, new patient testing, or routine physicals. Patients between 18 and 65 and have never been screened for or diagnosed with HIV can be screened easily with automated standing orders. These patients can have an HIV screening auto-ordered during their visit unless they opt-out of being tested. 

Combining pre-visit planning and point of care testing can help standardize HIV screening in your healthcare center. Pre-visit planning includes scheduling patients for future appointments at the conclusion of each visit, arranging for pre-visit lab testing, gathering the necessary information for upcoming visits, and spending a few minutes to huddle and handoff patients. Point-of-care HIV testing refers to the practice undertaken by health care professionals of providing pretest counseling, post-test counseling, and a preliminary HIV antibody result at the time of testing outside of a designated laboratory. Using your EHR, identify patients at least a week before their scheduled appointment who may need HIV screening based on their reported visit reason (e.g. condom failure, annual visit). Plan to offer them POC HIV testing at their visit by setting up alerts for the physician in advance. Potential patients include:

• Pregnant women who have not been diagnosed with or screened for HIV
• Patients who reported occupational exposure to HIV (e.g., needlestick)
• Patients who report an acute illness (e.g., pneumonia)
• Patients who report high-risk sexual or injection drug use behavior (e.g., condomless sex in the last three months, sharing used needles)
• Patients presenting for STI (sexually transmitted infection) testing

Huddle Up

Huddles are an integral part of ensuring that clinic operations are running smoothly. Huddles can be used to discuss your clinic’s successes and challenges with providing HIV screening to patients. Consider adding HIV screening to your huddle sheets as a standing discussion item. Prepare data on your health center's HIV screening measures ahead of each meeting. Talk through missed screening opportunities with providers and set goals (with accompanying strategies) for reaching a target number of HIV tests for your health center.

Leveraging Your EHR Alert System

What if we told you there were strategies to reduce alert fatigue while subsequently increasing your HIV screening rates? When using an EHR, healthcare providers are often inundated with several alerts for various medical tests or procedures. Given that HIV screening is an essential strategy for ending the HIV epidemic, it makes sense for health centers to incorporate HIV testing alerts into providers’ workflow particularly if you do not yet have comprehensive population health tools. Here a few strategies for making good use of your EHR’s alert system:

• Tailor your alerts to the right individual. Identify appropriate staff in your health center that are responsible for providing HIV screenings to patients. This strategy will increase the number of alerts shown to individuals who can provide HIV screenings compared to those who cannot.
• Use a filtration system. Alerts, depending on your EHR, can be filtered based on importance and sensitivity. Alerts can be filtered using a sliding scale ranging from a low to a high filtration setting that shows only the most critical and relevant alerts. Consider setting HIV screening as a moderate or high alert. Frequency is an important concept to think about when employing this strategy. Work with your IT department to determine if the HIV screening alert should appear on a quarterly or annual basis. This strategy will help reduce fatigue, persuade providers to take the alert seriously, and ultimately offer the screening. Be sure to include options for overrides (e.g., “patient has been tested for HIV in the last three months”).
• Survey healthcare providers in your healthcare center to determine how HIV screening alerts should be used. System administrators and providers often work in silos and only interact when there are problems with an EHR. Be proactive and ask providers what they need to provide HIV screening practically. You can have a formal meeting with them or create a survey to get feedback on the alerts you are currently using for HIV screening. 
• Encourage providers to use alerts as a conversation starter with patients about HIV testing. Instead of being annoyed by alerts, encourage providers to use alerts as a conversation starter with patients in need of HIV testing. If possible, encourage providers to display a patient’s chart on a TV monitor or projector and talk through the HIV screening process or ask patients what they know about HIV. This approach changes how the provider values and uses the alert. It also creates an opportunity for the patient to be involved in their care.

No matter what approach you take, be patient. Increasing your health center’s HIV screening rates will take a bit of trial and error. Work collaboratively with your colleagues and leverage all of your health IT tools and EHR’s features to get the best results possible. 
 

References

10 steps to pre-visit planning that can produce big savings. (2015, September 4). American Medical Association. https://www.ama-assn.org/practice-management/sustainability/10-steps-pre-visit-planning-can-produce-big-savings

Arora, D. R., Maheshwari, M., & Arora, B. (2013). Rapid Point-of-Care Testing for Detection of HIV and Clinical Monitoring. ISRN AIDS, 2013. https://doi.org/10.1155/2013/287269

Haugen, J. (2015). Making EHR alerts work for your practice. Medical Economics, 92(24), 64.

Sinsky, C. A., Sinsky, T. A., & Rajcevich, E. (2015). Putting Pre-Visit Planning Into Practice. Family Practice Management, 22(6), 34–38. https://www.aafp.org/fpm/2015/1100/p34.html

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