Impact of a Statewide Public Health Mandate and Electronic Medical Record (EMR) Modification on Birth Cohort Hepatitis C Screening: A Single Center Experience: 926

Introduction: Hepatitis C (HCV) screening has become an increasingly important public health initiative with the advent of highly effective antiviral therapies. In 2012, the CDC recommended that the baby boomer generation- all adults born during 1945-1965- undergo a one-time testing for HCV. Despite this recommendation, screening rates have remained inadequate. In response to these shortcomings, on January 1, 2014, the New York State (NYS) Department of Health mandated that all hospital systems and healthcare providers in New York offer HCV screening to the 1945-1965 birth cohort. Several hospital systems have demonstrated high HCV screening rates with the adoption of electronic medical record (EMR) modifications. We sought to evaluate the implementation of an opt-in EMR strategy in the era of NYS's public health mandate on inpatient hepatitis C screening at a tertiary care medical center. Methods: In March 2014, we implemented an institutional opt-in EMR modification that identified patients born in 1945-1965 and prompted medical staff to offer HCV testing at the time of inpatient hospital admission. We retrospectively extracted information from our EMR database to determine the number of HCV tests ordered from January 1, 2013 to December 31, 2015, a timeframe spanning 1 year before the NYS mandate and implementation of our opt-in EMR modification and 2 years after their institution. Results: In 2013, 374 patients (180 birth cohort, 194 other) were screened for chronic hepatitis C. In 2014 and 2015, 1099 patients (800 birth cohort, 299 other) and 1179 patients (788 birth cohort, 391 other) were screened, respectively. There was a 15% screening acceptance rate according to a 9-month survey period in 2014. During a 12-month period from 2014-2015, 4.9% of the baby boomers who were screened were seropositive. 3.4% of non-baby boomers who were screened were seropositive. Conclusion: Our findings demonstrate a sustained, four-fold increase in birth cohort hepatitis C screening after a statewide public health mandate and the implementation of an opt-in EMR modification in an inpatient setting. Additional strategies, including the adoption of an opt-out EMR modification, need to be evaluated and adopted for continued growth in baby boomer hepatitis C screening.