Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers.

Despite effective treatment for chronic hepatitis C, deficiencies in diagnosis and access to care preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record-based prompt on hepatitis C virus (HCV) screening rates in baby boomers in primary care and access to specialty care and treatment among those newly diagnosed. We implemented an electronic health record-based "best practice advisory" (BPA) that prompted primary care providers to perform HCV screening for patients seen in primary care clinic (1) born between 1945 and 1965, (2) who lacked a prior diagnosis of HCV infection, and (3) who lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre-BPA and post-BPA screening rates were compared, and care of newly diagnosed patients was analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics and 28% were screened. HCV screening increased from 7.6% for patients with a primary care provider visit in the 6 months prior to BPA to 72% over the 1 year post-BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment, and 9 achieved sustained virologic response thus far. CONCLUSION: Implementation of an electronic health record-based prompt increased HCV screening rates among baby boomers in primary care by 5-fold due to efficiency in determining needs for HCV screening and workflow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into electronic health record systems to increase HCV diagnosis and linkage to care. (Hepatology 2017;66:1805-1813).

Anatomy of a malpractice lawsuit.

Given the prevalence of medical malpractice lawsuits, physicians are often thrust into the legal world without the education of a juris doctor. The risk of facing suit varies among specialties, but there is no guarantee any physician will proceed through his or her career without being a defendant in a lawsuit. Every physician stands a significant chance of being sued. Although a lawsuit is an exhausting and intimidating situation in and of itself, the ramifications of a plaintiff's verdict could have chilling effects on the physician's life, both professionally and personally. Therefore, it is imperative that every physician have an understanding of the legal process of which he or she may become involved. This article provides a practical guide for the physician, including the fundamental procedures of a medical malpractice lawsuit, the behavior that will be expected or required of the defendant physician, and the effect of disobeying the required procedures.