An electronic health record (EHR)-enabled quality improvement intervention significantly increased chlamydia and gonorrhea screening rates among sexually active adolescents, according to a study published online Nov. 5 in Pediatrics.
The research, led by Brian P. Jenssen, M.D., from the Perelman School of Medicine at the University of Pennsylvania, demonstrates how digital clinical tools can bridge gaps in preventative care. By integrating automated prompts and universal protocols into existing medical software, healthcare providers successfully moved away from inconsistent risk-based testing toward a more reliable, standardized screening model for teenagers.
This shift is critical because sexually transmitted infections (STIs) often remain asymptomatic in adolescents, leading to untreated complications. The study, which tracked 136,241 adolescents aged 15 to 19 years across 33 practices between 2021 and 2025, proves that systematic digital interventions can overcome the administrative hurdles that often lead to missed diagnoses in busy pediatric networks.
Digital Reminders Boost Infection Tests
- Digital Reminders Work: Using electronic health records to trigger “best practice advisories” ensures doctors don’t forget to order necessary tests during routine visits.
- Universal Screening is Superior: Moving from testing only “high-risk” patients to a “universal opt-out” approach (where testing is the default unless the patient declines) dramatically increases detection.
- Closing the Gap: These digital improvements work effectively across different races, ethnicities, and insurance types, helping to provide more equitable healthcare.
Digital tools drive higher screening rates
The intervention utilized a sequential quality improvement (QI) strategy to reshape how clinicians approached adolescent sexual health. This process involved implementing Adolescent Health Questionnaires to identify behavior, providing financial incentives to practices, and deploying EHR best practice advisories—automated alerts within the medical software that prompt a physician to take a specific action.
The network transitioned to universal opt-out protocols. In this model, screening is automatically offered to all sexually active patients unless they specifically choose to decline, rather than requiring the clinician to manually identify “at-risk” individuals through subjective questioning.
“Moving from risk-based to universal opt-out screening appears to have made the biggest difference,” Jenssen said in a statement, noting that the approach can be adapted by other primary care practices.
Testing Increases Infection Detection
The implementation of these digital protocols led to a dramatic rise in both the frequency of testing and the subsequent identification of infections. As testing volume increased, so did the number of confirmed cases, providing a more accurate epidemiological picture of the adolescent population within the network.
For female patients, screening rates climbed from about 25 to 75 percent. During the period of highest testing volume, monthly chlamydia case counts for females rose from about eight cases to 25 cases. Male patients saw similar progress, with testing rates increasing from about 20 to 75 percent and monthly chlamydia cases rising from about four to 16.
Screening Improvements Show Equity
One of the most vital findings of the study is the consistency of the results across diverse populations. The improvements in screening were observed across all demographic groups, regardless of the patient’s race, ethnicity, or insurance type. This suggests that EHR-enabled interventions can serve as a tool for reducing healthcare disparities in STI prevention.
The study also noted an increase in overall well-care visits within the network, which averaged an increase from 1,472 to 1,681 visits per month over the study period. This rise in clinical engagement provides a broader window for clinicians to implement preventative measures and health education.
The success of this large-scale pediatric network model suggests that the integration of automated clinical decision support is a viable path for reducing the long-term burden of STIs in adolescent populations.
References
- Pediatrics (Journal)
