Electronic Patient Records May Reduce Time to Treat for Chlamydia

Laurie Barclay, MD

September 18, 2010

May 26, 2010 — Use of electronic patient records (EPRs) may reduce the time-to-treat interval for chlamydia and potentially other sexually transmitted infections (STIs), according to the results of a study published online May 26 in Sexually Transmitted Infections.

"The longer an STI goes untreated, the more risk there is of onward transmission and of clinical complications," write M.G. Brook, MD, from the Patrick Clements Clinic at Central Middlesex Hospital in London, United Kingdom, and colleagues. "Any system that makes patient recall more efficient and effective therefore serves to reduce the spread and complications of STIs. Theoretically, [EPRs] are more efficient to use than paper-based records for recall due to instant access and the use of failsafe mechanisms which ensure better patient contact information."

The goal of this study was to assess the time interval for recall and treatment of patients with untreated chlamydia who were seen at a sexual health clinic before and after EPRs were introduced. For each of 52 consecutive qualifying patients seen from January to March 2007 (paper case records) and 2009 (EPRs), time intervals were measured between first attendance, first positive result received, first attempted patient contact, and attendance for treatment.

The median time interval between receiving a positive chlamydia result and treatment decreased by 11.5 days from 2007 to 2009 (median, 15 days in 2007, 3.5 days in 2009). Even though results took 2 days longer to arrive in 2009 than in 2007, the time between first attendance and treatment decreased by 9.5 days from 2007 to 2009 (median, 21 days in 2007, 11.5 days in 2009).

In 2007, 38% of patients were treated within 2 weeks of a positive result compared with 94% in 2009. EPRs were also associated with a greater proportion of patients successfully recalled by telephone (26/44 [59%] in 2007 vs 46/52 [88%] in 2009), resulting in earlier treatment.

"Compared with paper notes, EPR decreased the time to recall, by eliminating three time-delaying patient recall processes," the study authors write. "The 'time to treat' interval was dramatically reduced after the introduction of EPR. Clinics using paper notes should consider switching to EPR as a means of improving STI recall efficiency."

Limitations of this study include possible confounding factors.

"We suggest that with the increasing use of non-invasive Chlamydia screening methods such as urine sampling, and more effective patient recall, new national standards should be set for the time taken to recall and treat infected patients," the study authors conclude.

"Future research should look at how additional automated recall technology can be added to current EPR systems and what effect they would have on patient recall for treatment. Appropriate use of technology greatly improves our ability to treat patients rapidly, and we should strive to use all available methods, for the good of our patients and the betterment of public health."

Dr. Brook has performed training and lecturing on the use of EPR for Blithe Computer Systems Ltd in return for educational donations to the clinic.

Sex Transm Infect. Published online May 26, 2010.

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