Introduction: Hepatocellular Carcinoma (HCC) is currently the 4th leading cause of death worldwide and the fastest growing cause of cancer-related deaths in the United States. This increase of incidence in HCC is largely due to the prevalence of Hepatitis B, Hepatitis C, alcoholic liver disease, as well as the surge in obesity-related fatty liver disease. The prognosis of patients diagnosed with HCC remains poor with a 5-year survival rate of 18%, largely due to late detection. Current screening guidelines recommend abdominal ultrasound every 6 months 1/- AFP, and bi-annual screening has been shown to reduce mortality by 37%. Dynamic contrast enhanced CT and MRI are alternatives with higher sensitivity but have never been studied looking at mortality. The goal of this study is to determine how the healthcare system is meeting the needs of these patients and find ways to provide better care for this population. Methods: Using tools within the Electronic Medical Record (EMR), we were able to determine that the number of patients in our community with diagnoses of cirrhosis and being up to date on HCC screening was 189/1123 (16.8%). Working with IT, we developed a Best Practice Advisory (BPA) to ”flag” these patients who have not undergone HCC screening within the past 6 months when seen by outpatient providers. When accepted, the order for abdominal ultrasound was automatically sent and associated with the corresponding diagnosis. Results: The project was initiated in January of 2020 but due to the COVID pandemic, the BPA did not “go live” until October 14th, 2020. At the 6-month mark, the data was analyzed and while the screening rates only increased to 18.2% (221/1213), the incidence of ultrasound usage increased 123% with no change in usage of CT or MRI. Most common causes for the BPA being bypassed were “Not addressed this visit” and “Follows with Gastroenterology.” Conclusion: As the burden of liver disease increases with the obesity epidemic and incidence of NASH, mortality from liver disease is expected to increase. How can we use EMR to continue to improve screening rates in these patients and identify areas of deficiency? We will continue to monitor efficacy of the BPA implemented, with future areas of focus being revamped patient education on hospital discharge, improved follow up, and identification of different socioeconomic barriers to patient care..
Improving hepatocellular carcinoma screening in patients with cirrhosis