Multisite implementation of a sexual health survey and clinical decision support to promote adolescent sexually transmitted infection screening.

Abstract

Background: Adolescents are at high risk for sexually transmitted infections (STIs) and frequently present to emergency departments (EDs) for care. Screening for STIs using confidential patient-reported outcomes represents an ideal use of electronic screening methodology.

Objectives: The objectives of this study were to implement a patient-facing, confidential electronic survey to assess adolescent risk for STIs and consent for testing with integrated provider facing electronic clinical decision support (CDS) across six geographically dispersed pediatric EDs and evaluate implementation based on survey and CDS usage metrics.

Methods: A pilot site provided code for the electronic survey, data query, and CDS templates to six EDs. Institutions identified necessary information technology (IT) personnel, completed local build, and made modifications to suit individual site workflow variations with all sites successfully deploying the electronic survey with electronic health record (EHR) -embedded CDS.

Results: 6,165 adolescents completed the confidential health survey between April 12, 2021 - September 25, 2022 out of 79,780 eligible adolescents. The CDS was triggered indicating the patient was at-risk or consented to STI testing across all six sites 2,058 times. The average percentage of time the CDS was acknowledged by a provider was 81.6% (range 45.7% - 97.6%). The median number of providers who acknowledged each instance of the CDS was 2.0. STI testing was ordered from the CDS on average 47.3% of the time. CDS acknowledge selections of "other" and "[testing] already ordered" were the most frequent indications STI testing was not ordered from the CDS.

Conclusions: Successful deployment of patient-facing screeners with integrated electronic CDS across multiple healthcare institutions is feasible. A combination of different types of IT and informatics expertise combined with local knowledge of clinical workflows is essential to success.