Medical informatics is mainly used to communicate between medical staff. Medical informatics applications that engage patients can improve the efficiency of a patient's time in a physicians's office or medical clinic. Audio-Computer Assisted Survey Interview (audio- CASI) is “Patient targeted informatics” that increases reporting of behaviors associated with sexual behavior, drug use, and violence by up to 15 fold. Audio-CASI allows respondents to answer embarrassing questions without direct participation of an interviewer and avoids obstacles such as poor literacy. Respondents can use multiple languages, listen to and read questions simultaneously. We are running a program using an audio-CASI based Hepatitis Survey Kiosk (HSK) in urban Federally Qualified Health Centers (FQHC) and an academic charity care clinic in Newark New Jersey and Jersey City.


Patient Navigator-PN, Navigator Assistant-NA

Of 1016 patient survey initiations, 980 patients completed the survey. 246 acknowledged having “ANY” risk factor. There were 681(75%) females and 299 (25%) males who completed the survey.

The race and ethnicity of the patients were: 403 Non-Hispanic Black, 104 Other, 269 Hispanic White, 66 Hispanic Black, 28 Pacific Islander, 36 Native American, 54 Non-Hispanic White, and 15 Asian.

Language use was: 630 English, 70 Creole and 286 Spanish. The distribution for region of birth was: 331North America, 282 Caribbean, 116 South America (non Amazon Basin), 33 Sub-Sahara Africa, 48 Central America, 62 Amazon Basin, 16 North Africa, 6 Pacific Islands or Rim, 6 South East Asia, 6 East Europe, 5 Western Europe, 3 Central Asia, 4 Middle East, and 68 unknown.

Of 246 patients identified in need of blood testing for chronic viral hepatitis, 150 patients had a complete chronic hepatitis screen (HCV antibody, HBV surface antigen, HBV core antibody, HBV surface antibody).

Serology for chronic viral hepatitis was: 14 HCV antibody positive, 6 HBV surface antigen positive, 8 HBV core positive/surface antibody negative/surface antigen negative, 22 HBV core positive/surface antibody positive, and 96 HBV surface/core antibody and surface antigen negative. Of the 96 patients who were HBV naïve, 65 (67%) acknowledged having “ANY” risk factor for chronic viral hepatitis. Thus far 70 patients are in the process or have completed HBV vaccination. Of six patients testing HBV surface antigen positive, 3 were Haitian, and 1 was Sub-Sahara African. Only one of the six HBV surface antigen positive patients acknowledged having “ANY” risk factor for chronic viral hepatitis. Of 14 patients testing HCV antibody positive, 11 acknowledged having “ANY” risk factor for chronic viral hepatitis. Of patients in need of HBV vaccine, 34% were identified as a result region of endemic risk only. As an internal control, we asked patients if they had a history of viral hepatitis and assessed the number of patients acknowledging “ANY” risk factor or birth in a region of endemic infection. 37 of 66 (56%) patients noting a history of viral hepatitis acknowledged “ANY” risk factor. An additional 6 patients noting a hepatitis history, not acknowledging a risk factor, were born in a region of endemic risk. Of the 66 patients indicating a hepatitis history, hepatitis blood test results were available in 27 patients. Of these 27 patients, 7 were HCV antibody positive, 1 was HBV surface antigen positive, and 14 were HBV naive.

Patient Navigation was used to help obtain treatment evaluation in 16 of 22 patients with positive serology for chronic viral hepatitis. The patient navigator also runs a liver cancer high risk registry to insure patients at high risk for liver cancer receive routine surveillance. Routine surveillance includes an imaging study of the liver and a blood test called alpha fetal protein.