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Interventions Using Electronic Medical Records Improve Follow Up of Infants Born to Hepatitis C Virus Infected Mothers

Abughali, Nazha MD*; Maxwell, Jessie R. MD; Kamath, Aparna S. MD, MS; Nwankwo, Uchebike MD§; Mhanna, Maroun J. MD, MPH*

The Pediatric Infectious Disease Journal: April 2014 - Volume 33 - Issue 4 - p 376–380
doi: 10.1097/INF.0000000000000129
Original Studies

Background: The American Academy of Pediatrics recommends hepatitis C virus (HCV) antibody testing for all HCV- exposed infants at age ≥ 18 months. However, many of these infants are not appropriately tested. In 2006, the pediatric infectious disease service (PIDS) at our institution implemented interventions using electronic medical records (EMR) to improve appropriate HCV testing for HCV-exposed infants.

Methods: Two-part study: During the first period (January 1, 1993, to December 31, 2005), medical records of all infants born to mothers with HCV were retrospectively reviewed for patient’s demographics and infant’s HCV testing. PIDS interventions included contacting the primary care physician through EMR requesting HCV testing for children without proper testing. During the second period (January 1, 2006, to December 31, 2011), interventions using EMR were implemented prospectively, including PIDS consultations during birth hospitalization for all HCV-exposed infants, addition of HCV exposure to the EMR problem list and communication with PCPs via the EMR to assure appropriate HCV testing.

Results: About 67,112 infants were born during the study period; 280 had maternal HCV infection and 193 continued to receive medical care at our institution. PIDS interventions using EMR resulted in a significant improvement of appropriate HCV testing among HCV-exposed infants from 8% (10/121) to 50% (36/72); P <0.0001. It also resulted in the identification of 5 new HCV-infected children; 3 of them were born before 2006 and previously undiagnosed.

Conclusions: Interventions using EMR improved the identification and appropriate HCV follow up of infants born to HCV-infected mothers.

From the *Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH; University of New Mexico Hospital, Albuquerque, NM; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; and §Mercy Health Physician Partners, Grand Rapids, MI.

Accepted for publication October 10, 2013.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Nazha Abughali, MD, MetroHealth Medical Center. 2500 MetroHealth Drive, Cleveland, OH 44109. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.