QIM19-121: Improving Testing for Hepatitis B Before Treatment With Rituximab Through Automated Electronic Health Record Alert System: A Single Institutional Retrospective Review and Quality Improvement Project

Abstract

Introduction: Individuals with chronic hepatitis B virus infection (HBV) or previous infection with HBV are at increased risk of HBV exacerbation or reactivation when they receive treatment with anti-CD20 monoclonal antibodies like rituximab (RTX). HBV screening and appropriate use of prophylactic antiviral therapy is recommended to prevent reactivation. A software program named Beacon Oncology was integrated into Epic, which creates an automated alert for HBV screening before starting first dose of chemotherapy with RTX and results the previously resulted HBV test results. Retrospective data analysis for screening was done after implementation of the software and its impact was assessed. Methods: We conducted retrospective chart review on screening for HBV before starting treatment with RTX before and after implementation of the electronic health record (EHR) alert system. Results: A baseline review (before software introduction) of 165 patients showed that only 40 (24%) had screening tests for HBV (hepatitis B surface antigen [HBsAg] and hepatitis B core antibody [anti-HBcAb]) before receiving rituximab. Following introduction of the automated electronic alert system, chart review for HBV testing rates among patients being initiated onto rituximab was performed. There was a marked increase in pre-rituximab testing for HBsAg from 24% to 88% and for anti-HBcAb from 24% to 76%. The remainder cases also had the HBV screening done but after the first dose of the RTX chemotherapy between 1.3 to 7.5 days. There was one patient identified as anti-HBcAb-positive after the implementation of the protocol. Conclusions: This retrospective single-institution study clearly indicates that simple strategies can markedly improve appropriate HBV screening. There was a more than 3-fold increase in HBV testing before the first dose of HBV after implementation of the EHR alert system. There has been increased use of EHR alert systems recently to improve implementation of clinical guidelines, and they have been shown to improve patient outcomes. In conclusion, an automated EHR alert directed toward screening for HBV before initiating RTX effectively increased the number of HBV screening tests completed, and similar protocols could be implemented to identify other at-risk patient groups.