Mission Impossible? Development of an EMR-Driven Screening Pathway for HCV Patients in Alberta.

MISSION IMPOSSIBLE? Development of an Electronic Medical Record - Driven Screening and Treatment Pathway for Patients with Hepatitis C in Alberta

By: Finley Whyte, Intermediate (9/10)

Fig1: Hepatitis C Virus Trajectory

Fig2: Disease Progression Chart

Fig3: HCV Risk Map

HCV EPIDEMIOLOGY AND RISK

Hepatitis C Virus (HCV) is a high morbidity disease identified by the World Health Organization as a Top 10 globally eradicable disease. 1

The following indicators are consistent:

diagnosis at late stage with severe liver damage (i.e. cirrhosis).3

presents in marginalized populations; Health Canada (2025)4 estimates ~22% of intravenous drug users have HCV.

access barriers are stigma, discrimination, inconsistent transportation, unstable housing/ homelessness. 5 - 7

HCV IN ALBERTA:

In Alberta, there are ~19,000 patients10 with a lower prevalence (5/ 1000 persons) in Calgary versus Edmonton (8/ 1000 persons). 8,9 There may be a higher prevalence in Indigenous communities on Nations (7.4/ 1000), and off Nations (12.3/ 1000). 11, 12

PROJECT OBJECTIVES:

In Alberta, there is no standardized screening pathway for HCV in the community.

In this project:

I built a screening instrument for HCV using data in the electronic medical record (EMR).

My tool is implemented in 4 EMRs of 327 family doctors in 87 clinics in Calgary; it has screened over 91,735 patients.

I used predictive AI to create a clear pathway of clinical and socio-demographic risk factors which identify untreated undiscovered patients so they can be linked to, potentially curative, specialist care.

I believe people should be able to self screen for HCV. To bridge this health system gap, I developed an easy-to-use smart-phone compatible app so anyone can test for their risk exposure.

Image 1: Meta-Analysis Report (Full Report available upon request)

Image 2: Schemata Meta-Analysis Methods

Image 3: Risk Populations as Per Meta- Analysis

Image 4: Primary Care Snapshot

Image 5: Finley Whyte: Invitation to Participate in Study

Image 6: Privacy, Ethics Approval

HYPOTHESIS

If an evidence-based, EMR- driven screening tool can be developed for HCV, then there will be an effective method to proactively identify these high-risk patients.

METHODS

Phase I: Background Research (Meta-Analysis)

Conducted to identify best screening criteria as per peer-reviewed literature.

Search databases: CINHAL, EmBase, PsychInfo, PubMed, Web Science, grey literature (2020 to present).

Keywords: ‘HCV positive’, ‘screening’, ‘clinical pathway(s)’, ‘primary care’, ‘family medicine.’

Parameters: 'patients 18+' (b. year 2007 or earlier), 'HCV, 'serology'; excluded case studies, single subject designs (Full Report available).

Phase 2: Cohort Collection

Survey administered to clinics to determine which may have (suspected) HCV patients; distribution via communication portal, hard copy or QR code.

Response rate: 111/ 327 (33.9%).

111 physicians indicated they may have HCV patients; open to further screening.

Phase 3: Building the AI Tool, Implementation

AI - compatible risk screening instrument built and integrated into 4 EMRs: Aviva, CHR, MedAccess, Accuro.

Tool screened 91,735 patients in the clinics of 111 family physicians in South Calgary.

This tool is still live, screening in community clinics.

Phase 4: Data Extraction, Analysis

The tool identified 50 undiscovered patients fitting the risk criteria for HCV.

Patient data was extracted (n= 50); statistical analysis completed.

T- tests and odds ratios compared risk factors between HCV+ and HCV- patients; best clinical, socio-demographic factors for early diagnosis identified.

Phase 5: Patient App

Literature suggests HCV patient population may be low compliance for regular screening by physicians.

An app was developed to allow patients to self-assess and determine whether going to see their family doctor is recommended.

RESULTS

Image 1: Table 1: Demographics and Behavioral Characteristics of Patients Screened for HCV in South Calgary

Image 2: Graph 1: HCV Patients stratified by Alcohol Frequency Use Test (called "Audit C+ Test") (n=37), OR - 6.14 (p, 0.0001)

Image 3: Graph 2: HCV Patients stratified by Blood/ Blood Products Received Ever (n=17),

OR = 3.25 (p< 0.0004)

Image 4: Graph 3: HCV Patients stratified by IV Drug Use (n=50), OR = 308.6 (p< 0.0001)

Image 5: Graph 4: Referrals to Specialist Care of Patients in this Study

ANALYSIS

The results show a clear concentration of HCV cases within specific behavioral and social risk groups rather than even distribution across the population.

Most HCV cases are male (OR = 1.72, p < 0.047) suggesting a gender imbalance that reflects different exposure patterns rather than biological susceptibility.

The data shows strong clustering around substance use (OR = 308.6, p< 0.0001) and alcohol abuse (OR = 6.14, p< 0.0001); nearly all heavy drinkers (n = 35/37) are current users (OR = 1.13, p = 0.0378) indicating an ongoing behavioral risk factor.

Drug use categories form the strongest association (OR = 308.6, p < 0.0001) which may be consistent with blood-borne transmission linked to needle sharing and unsafe practices. In contrast, prior blood transfusion exposure accounts for a smaller share of positives (n = 17/ 50, 34%), albeit it is still statistically significant (OR = 3.25, p < 0.0004). This suggests, in this cohort, medical exposure routes are important, but behavioral transmission routes may be still more influential.

Socioeconomic risk patterns suggest that HCV is tied to overlapping vulnerability factors rather than any single variable alone.

Trends worth noting are ‘Presently Employed’ was significant (OR = 2.54, p < 0.003), education levels skew toward high school (OR = 8.49, p < 0.0001) or below and incarceration history (OR = 1.79, p = 0.04) suggesting a patient who is marginalized but still functional in society.

Race data (OR = 0.71, p = 0.139) cannot be reliably interpreted as most entries are unlisted. This weakens demographic conclusions and highlights a data quality limitation.

Of the 50 HCV patients discovered in this research, 47 patients were linked to specialist care; 3 patients declined treatment.

Of the 47 patients who received care, about 50% have been cured and about 50% are presently are on an active treatment regimen.

Image1: "Whyte Risk Assessment Protocol (WRAP)" App

Image2: Finley Whyte clinical shadowing, Division of Hepatology, Foothills Medical Center, Calgary

HYPOTHESIS REVISITED:

My hypothesis was correct: an evidenced-based EMR-enabled pathway can screen for HCV patients in the community.

A standardized screening pathway supports early identification, expeditious linkage to specialist care, and reduces loss to follow-up.

CONCLUSIONS, REAL LIFE APPLICATIONS:

Research suggests interventions target high-risk groups, rather than screening broadly.

Data supports combining medical care with social/ behavioral supports; infection drivers are connected to life circumstances and risk environments, not just medical events.

Recommended that screening is offered at addiction treatment programs, harm- reduction clinics, supportive housing sites, in correctional/ recovery facilities. Screening herein should reducte new infections and limit severe liver diseases.

Data suggests early behavioral intervention is important (i.e. heavy drinker 'present' vs. 'past'). Risk is connected to long exposure histories- earlier prevention may reduce later disease burden.

PATIENT SELF-SCREEN APP:

The "Whyte Risk Assessment Protocol (WRAP)" App developed to support patient self screening.

Patients assess their personal risk for HCV exposure, relevant to patients who only visit physician when cued.

LIMITATIONS

Small sample size: some variables approaching statistical significance, but more sampling will clarify risk relevance.

EMR documentation is inconsistent: physicians used wide range of terms for same/ similar events, immense variability.

AI tool build on binary keywords: (i.e. risk presence/ absence), expansion for synonyms may capture more patients.

All patients screened (n= 91,735) were attached to family doctor; those without a doctor are not captured.

EXTENSION

This work supports the implementation of a standardized HCV screening pathway for:

Early detection (reduced mortality) 14-17

Streamlining workflows (improved triage/ referrals) 15,18,19

Improved documentation (patient safety) 14,17,18

Reduced health care costs (fewer morbidities)16,17,19

WHAT'S NEXT?

Research is ongoing with Primary Care Network partners in Calgary, Edmonton, rural areas (August 2026), with the goal of province-wide implementation (December 2026).

RESEARCH SUBMISSIONS:

Submissions to provincial, national, international meetings are:

Image1: Poster: Alberta Family Medicine Symposium, March 2026

Image2: Abstract: European Association Symposium Liver, May 2026

Image3 - 4: Abstract: Canadian College Health Leaders, June 2026

Image 1: Finley Whyte shadowing Dr. Mayur Brahmania (Hepatologist), Foothills Medical Center, Calgary

ACKNOWLEDGEMENTS

●      Dr. Mayur Brahmania, MD, MPH, Calgary Liver Unit, Faculty of Medicine, University of Calgary

●      Ms. Linh Tran, South Calgary Primary Care Network

●      Mr. Jati Pujol, South Calgary Primary Care Network

Special thanks to the family physicians and health care professionals in South Calgary Primary Care Network who participated in (and continue to participate in) this research study.

REFERENCES FOR FIGURES IN BACKGROUND INFORMATION

Figure 1: Hepatitis C Virus Trajectory

Thomas DL, Seef LB. Natural history of Hepatitis C. Clin Liver Dis. 2005; 9: 383-98.

Figure 2: Disease Progression Flow Chart (without Patient Co-Morbidities)

Hofer H, Watkins-Riedel T et al., Spontaneous viral clearance in patients with acute Hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology. 2003; 37:60-4.

Figure 3: HCV Risk Mapping in Alberta

Brahmania M et al., HCV Re-Link: Developing and evaluating tailored methods to improve linkage to care for patients with HCV in Alberta, Division of Gastroenterology and Hepatology, University of Calgary, 2024.

REFERENCES

WHO, Global Hepatitis Report 2024, Global hepatitis report 2024: action for access in low- and middle-income countries

Public Health Agency of Canada, “CATIE Fact Sheet: The Epidemiology of Hepatitis C in Canada,” fs-epi-hcv-en-10-2025.pdf

Brahmania M, et al., HCV Re-Link: Developing and evaluating tailored methods to improve linkage to care for patients with HCV in Alberta, Canada Department of Medicine: Division of Gastroenterology and Hepatology, University of Calgary & University of Alberta, 2024

Hepatitis C in Canada: Surveillance Report, Hepatitis C in Canada: 2021 surveillance data update - Canada.ca, updated in July 2025

CDC Clinical Overview of Hepatitis C, Clinical Overview of Hepatitis C | Hepatitis C | CDC

EASL Practice Guidelines, EASL Recommendations for the Study of Hepatitis C, Journal of Hepatology 2020 vol. 73 pg. 1170–1218

Canadian Task Force for Preventative Health Care: Guidelines for Primary Care, Hepatitis C—Clinician Summary – Canadian Task Force on Preventive Health Care

Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis. 2005;9:383-98

Hofer H, Watkins-Riedel T, Janata O, et al. Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology. 2003; 37:60-4

Gill S, Rizwan S, et al., The effect of spatial variation in linkage to care and treatment rates among patients with Hepatitis C: A Canadian population-based study. Canadian Liver Journal. 2024; 11: 447-58

Gitau Z, Suarez-Ariza C et al., Epidemiology of Hepatitis C in Alberta, Saskatchewan, and Manitoba compared to Canada. Journal of Infection and Public Health. 19 (2026) 1031–48.

Dunn K, Wardman D et al., Epidemiology of Chronic Hepatitis C in First Nations Populations in Canadian Prairie Provinces. Pathogens 2025 14 693-708.

Ha S, S Totten et al., Hepatitis C in Canada and the importance of Risk-based Screening. Can Commun Dis Rep. 2016 Mar 3;42(3):57–62.

CDC Clinical Screening and Diagnosis for Hepatitis C https://www.cdc.gov/hepatitis-c/hcp/diagnosis-testing/index.html

Sarkeala T Introduction to cancer screening: balancing benefits with potential harms European Journal of Public Health 35 (4) 2025

Iagorri N, E Spackman Assessing the value of Screening Tools: reviewing the challenges and opportunities 39 (17) 2018

Alberta Health Services Clinical Pathways and Specialty Access  https://www.specialistlink.ca/clinical-pathways-and-specialty-access

Weidland D Why Use Pathways rather than Clinical Practice Guidelines? 174 (6) 12 592-595

Hepatitis C Elimination Pathway Roadmap Ontario Full Report  https://endhepc.ca/roadmap/