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Assessing State EHDI Programs’ Capability for Standards-Based Health Information Exchange Jim Jellison, MPH Deb Assessing State EHDI Programs’ Capability for Standards-Based Health Information Exchange Jim Jellison, MPH Deb Bara, MA

PHII. org Topics • Overview of EHDI • Barriers to EHR – Public Health PHII. org Topics • Overview of EHDI • Barriers to EHR – Public Health interoperability • EHDI interoperability capability maturity model

PHII. org PHII’s Mission To improve health outcomes worldwide by transforming health practitioners’ ability PHII. org PHII’s Mission To improve health outcomes worldwide by transforming health practitioners’ ability to apply information effectively. We do: • Business process analysis, systems requirements • Evaluations, recommendations • Training

PHII. org Early Hearing Detection & Intervention (EHDI) • Goal: promote children’s communication and PHII. org Early Hearing Detection & Intervention (EHDI) • Goal: promote children’s communication and development from birth by detecting hearing loss and intervening. • Universal Newborn Hearing Screening: – 1989: ~3% ; 2011: >98% – Hearing loss prevalence: 1. 5 per 1000 screened – Of those screened, 35% LTF/LTD • Providers often lack EHDI knowledge, skills Sources: CDC MMWR (1/30/2004) CDC Annual EHDI Data Reports Shulman, et al. Pediatrics (Suppl. , Aug 2010)

PHII. org EHDI Clinical Workflow Pass Birth Goal: Hearing Screen 1 Month Fail No PHII. org EHDI Clinical Workflow Pass Birth Goal: Hearing Screen 1 Month Fail No Hearing Loss Audiologic Exam 3 Months Pass No Hearing Loss Fail Early Intervention 6 Months 2014 Clinical Quality Measure: % screened for hearing loss before hospital discharge Sources: Joint Committee on Infant Hearing (JCIH); Centers for Medicare & Medicaid Services (CMS)

PHII. org EHDI Information Exchange Context Public Health Hospital Birthing Center Birth Event Birth PHII. org EHDI Information Exchange Context Public Health Hospital Birthing Center Birth Event Birth Registry Birth Event Screening Device Screening Results EHDI Care Plan Pediatrician Primary Care

PHII. org EHDI Information Exchange Standards (IHE Profiles) Public Health Hospital Birthing Center Newborn PHII. org EHDI Information Exchange Standards (IHE Profiles) Public Health Hospital Birthing Center Newborn Admission Notification Information Birth Registry (Birth Event) Screening Device Enterprise Communication* Pediatrician Acknowledgments: IHE QRPH Domain Lisa Nelson (consultant) Lura Daussat (OZ Systems) EHDI Early Hearing Care Plan* Primary Care * To be replaced with EHDI Profile

PHII. org IHE EHDI Profile (CCD) Right Ear Outcome Assessment Left Ear Hearing Plan PHII. org IHE EHDI Profile (CCD) Right Ear Outcome Assessment Left Ear Hearing Plan of Care Risk Indicators Problem Concerns Procedures Plan of Care Family History Congenital Conditions Prospective Procedures Goals, Reminders Screening Result

PHII. org Don’t understa nd IHE, HL 7 stuff Reciproc al trust, value Doing PHII. org Don’t understa nd IHE, HL 7 stuff Reciproc al trust, value Doing well enough, why bother So Why Are We Not Interoperabl e ? ? ? Agency prioritie s are MU, not EHDI Don’t have the staff Not using EHRs, EHDI-IS

PHII. org Performance Improvement Tool Receiving notices Sending care plans De-duplicating events Informatics strategy PHII. org Performance Improvement Tool Receiving notices Sending care plans De-duplicating events Informatics strategy Workflow Policies Data sharing agreements Privacy, confidentiality Interoperability Workforce IT Architecture Infrastructure SNOMED, LOINC Data & Standards HIE Adapted from C 4 ISR AWG Architectures Working Group, Department of Defense. 1998. Levels of Information Systems Interoperability (LISI). Washington, D. C. : United States Department of Defense. HL 7 IHE

PHII. org Capability Maturity Model Level 5 Optimized Level 4 Measured Level 3 Defined PHII. org Capability Maturity Model Level 5 Optimized Level 4 Measured Level 3 Defined Level 2 Managed Level 1 Initial Level 0 None Use evaluation results to improve Evaluation of procedures, processes Routine processes, documented procedures; Established governance, policies Repeat early successes; Begin to establish processes Isolated, ad-hoc efforts; Individual heroics No awareness or efforts Adapted from the Capability Maturity Model developed by the Software Engineering Institute at Carnegie Mellon University. Capability Maturity Model is registered service mark of Carnegie Mellon University.

PHII. org Level 5 Optimized Workflow Can the EHDI program identify all live birth PHII. org Level 5 Optimized Workflow Can the EHDI program identify all live birth events in its jurisdiction? Use of evaluation findings to improve live birth event identification process. Level 4 Measured Evaluation of automated live birth event identification process. Level 3 Defined Automated approaches; Consistently good results; Few unresolved duplicate birth events. Level 2 Managed Combine manual, automated approaches; Inconsistent results; Some unresolved duplicates. Level 1 Initial Manual; Inconsistent results; Many unresolved duplicate birth events. Level 0 None Unable to conduct these activities.

PHII. org Level 5 Optimized Policies Does your agency have a governance process that PHII. org Level 5 Optimized Policies Does your agency have a governance process that guides IT projects? Agency uses evaluation findings to improve governance of information systems development. Level 4 Measured Agency has established such a governance process and evaluates how well it guides IT projects towards agency objectives. Level 3 Defined Level 2 Managed Agency has established such a governance process and exercises it regularly. Agency has made sustained attempts at governing information system projects. Level 1 Initial Agency has made isolated, ad-hoc efforts to govern information systems projects. Level 0 None No such governance structure.

PHII. org Benefits to EHDI Program • Better understanding of current interoperability readiness • PHII. org Benefits to EHDI Program • Better understanding of current interoperability readiness • Evidence for additional resources • More collaboration between EHDI, IT, agency leadership • More informed national strategy for capacity building

PHII. org Thank you! For additional conversation please contact Jim Jellison jjellison@taskforce. org PHII. org Thank you! For additional conversation please contact Jim Jellison [email protected] org