The STD Clinic Electronic Medical Record As a Tool for Program Evaluation and Research

Background: In 2005, the Denver Metro Health (STD) Clinic (DMHC) implemented a web-based electronic medical record (EMR) system, specifically designed for patient management and disease reporting. However, the system was built with sufficient flexibility to allow for the (temporary) routine collection of supplemental data to support program evaluation and research (PE/R) functions.

Objectives: To illustrate the utility of the DMHC EMR system in four recent PE/R projects:  1) Collection of data on Internet sex seeking to investigate its relationship with prevalent STI; 2) Evaluation of a policy change to routine HIV testing among new clinic patients; 3) Evaluation of the Gram-stained smear in the diagnosis of male urethritis; and 4) Implementation and evaluation of a new clinic policy regarding expedited partner therapy (EPT).

Methods: For each of the projects, (temporary) changes were made in the DMHC EMR to allow for routine supplemental data collection as well as the inclusion of prompts requiring specific clinician actions.

Results: 1) Recruiting sex partners on the Internet was not found to be a risk factor for prevalent STI’s (Al-Tayyib et al. Sex Transm Infect 2009); 2) An STD clinic policy change and the provision of clinician prompts resulted in near universal HIV testing among new clinic patients (Brooks et al. Sex Transm Dis 2009); 3) Evaluation of >11,000 Gram-stained smears suggested that current diagnostic criteria for male urethritis are too stringent  (Rietmeijer et.al. Sex Transm Dis 2011);and 4) Introducing clinician prompts in the EMR resulted in a near doubling of eligible patients receiving EPT; those receiving EPT had lower rates of re-infection (Mickiewiz et al. ISSTDR 2011).

Conclusions: A flexible EMR can be an efficient tool in STD clinic-based PE/R.  Moreover, routine collection of supplemental data increases internal and external validity of PE/R projects and can be accomplished within IRB parameters.       

Implications for Programs, Policy, and Research: See Conclusions.