• Douglas Halket, Jimmy Dang, Anuradha Phadke, Channa Jayasekera, W Ray Kim, Paul Kwo, Lance Downing, and Aparna Goel.
• Division of Primary Care and Population Health, Stanford University, Palo Alto, CA, USA. dhalket@stanford.edu.
• J Gen Intern Med. 2022 Oct 1; 37 (13): 331833243318-3324.

ImportanceElectronic health record (EHR) tools such as direct-to-patient messaging and automated lab orders are effective at improving uptake of preventive health measures. It is unknown if patient engagement in primary care impacts efficacy of such messaging.ObjectiveTo determine whether more engaged patients, defined as those who have an upcoming visit scheduled, are more likely to respond to a direct-to-patient message with an automated lab order for hepatitis C virus (HCV) screening.DesignRandomized trial PARTICIPANTS: One thousand six hundred randomly selected Stanford Primary Care patients, 800 with an upcoming visit within 6 months and 800 without, born between 1945 and 1965 who were due for HCV screening. Each group was randomly divided into cohorts of 400 subjects each. Subjects were followed for 1 year.InterventionOne 400 subject cohort in each group received a direct-to-patient message through the EHR portal with HCV antibody lab order.Main Outcome And MeasureThe EHR was queried on a monthly basis for 6 months after the intervention to monitor which subjects completed HCV screening. For any subjects screened positive for HCV, follow-up through the cascade of HCV care was monitored, and if needed, scheduled by the study team.Key ResultsOf 1600 subjects, 538 (34%) completed HCV screening. In the stratum without an upcoming appointment, 18% in the control group completed screening compared to 26% in intervention group (p<0.01). Similarly, in the stratum with an upcoming appointment, 34% in the control group completed screening compared to 58% in the intervention group (p<0.01).ConclusionDirect-to-patient messaging coupled with automated lab orders improved HCV screening rates compared to standard of care, particularly in more engaged patients. Including this intervention in primary care can maximize screening with each visit, which is particularly valuable in times when physical throughput in the healthcare system may be low.© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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