CHLAMYDIA screening increased in primary care when medical assistants received real-time electronic medical record alerts.
A staff directed electronic medical record alert was associated with higher odds of chlamydia test ordering in primary care practices, according to findings from a cluster randomized clinical trial conducted across western Pennsylvania. The intervention targeted a persistent gap in preventive sexual health care: suboptimal chlamydia screening among sexually active women aged 24 years or younger.
The STD Testing in Outpatient Practices Study randomized primary care and obstetrics and gynecology offices in a 1:1 ratio to either a real-time electronic alert or usual care. The alert appeared for medical assistants as they prepared eligible female patients for office visits in an examination room, and it activated when patients had no documented chlamydia screening within the past year.
Electronic Medical Record Alert Drove Orders
Across 7,356 primary care encounters involving women aged 18 to 24 years, chlamydia tests were ordered more often in practices assigned to the alert than in control practices. Test orders occurred in 497 of 3,770 encounters in the intervention group, equal to 13.2%, compared with 135 of 3,586 encounters in the control group, equal to 3.8%.
After adjustment for baseline differences in practice screening, the electronic medical record alert was associated with increased odds of chlamydia test ordering versus usual care. The adjusted odds ratio was 2.74, with a 95% CI of 1.94 to 3.88.
The effect extended beyond reproductive health visits. The alert was associated with increased testing during reproductive health related visits, with an adjusted odds ratio of 2.80, and during visits for other medical reasons, with an adjusted odds ratio of 2.94.
No Effect Seen in Obstetrics And Gynecology
The same intervention did not increase screening in obstetrics and gynecology practices, despite 10,672 eligible encounters in that setting. This contrast suggests that alert performance may depend on clinic workflow, baseline screening patterns, or the staff role targeted by the intervention.
For primary care, however, a medical assistant directed alert appears to offer a practical route to improving chlamydia screening without relying solely on physician prompts. Because chlamydia remains the most commonly reported sexually transmitted disease in the U.S., improving routine screening could help reduce pelvic inflammatory disease and related reproductive sequelae among young women.
Reference
Wiesenfeld HC et al. A Staff-Directed Electronic Medical Record Alert to Increase Chlamydia Screening: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(5):e2615360.
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