Kate Spruit, RN, MSN Karl Soetebier, MAPW Building An Interoperable System of Systems for Perinatal Hepatitis B Case Management Presentation to National Immunization Conference March 31, 2011

ACCESS Access to affordable, quality health care in our communities RESPONSIBLE Responsible health planning and use of health care resources HEALTHY Healthy behaviors and improved health outcomes DCH Mission

FY 2011 DCH Initiatives FY 2011 Continuity of Operations Preparedness Customer Service Emergency Preparedness Financial & Program Integrity Health Care Consumerism Health Improvement Health Care Transformation Public Health Workforce Development

Purpose Create an efficient, paperless, secure, internet- based perinatal hepatitis B case management system that is user-friendly and provides complete data from reliable sources. Improve identification of hepatitis B infected pregnant women/mothers and care of exposed infants.

Pre-2011: Lab reports were entered manually into State Electronic Notifiable Disease Surveillance System (SENDSS) Reports on females between the ages years coordinator called provider for pregnancy status If pregnant, case was entered into the state database Database record was printed and then faxed to local HD (District) case manager Local HD case manages the pregnant woman/mother and care of infant for follow-up Background

Public Health Districts

Vision was to link SENDSS records Infected mother exposed infant Framework created to record all vaccines and serology tests on exposed infant 2009/10 Linking Systems o State Electronic Notifiable Disease Surveillance System (SENDSS) o Electronic Lab Reporting (ELR) o Electronic Birth Certificate (EBC) o Georgia Registry of Immunization Transactions and Services (GRITS) System Design Plan

ELR Hepatitis B Positives Filtered Females Age Pregnancy Status Determined QuestLabCorpGPHL Event compared to GRITS GRITS Real-time Query interface GRITS Data Perinatal Event Established Birth Established Compared To VEIS Transmitted To SENDSS Birth Data (VEIS) Creating an Integrated System

ELR from three major laboratories that service GA Positive results received within 5 days of blood draw Improved process increased the number of positive lab reports received Uploads directly into SENDSS Minimal provider f/u needed: periodically coded with reason for testing (i.e. “Supervision of normal pregnancy”) only EDC and birth hospital needed categorize lab reports electronically Electronic Lab Reporting (ELR)

Event tab added Provider follow up ELR coded reason for testing as pregnancy Event tab fields: Providers, fax and phone numbers Infant demographics Vaccine dates and times Serology date and results SENDSS

Infant record located in SENDSS Local HD can access and enter their case findings State and local HD have shared view of status Multiple children tracked under the same mother in the same place Serial pregnancies and multiple births Improvements

Perinatal Event Tabs

Recorded within 5 days of delivery-GA law Opportunity to administer HBIG if missed Birth certificate information uploaded to SENDSS: Mother’s maiden name For child identification Country of Birth (helpful for language barriers) Birth wt, time of birth, hepatitis B and HBIG administration dates WIC and Medicaid participation (tracking) Electronic Birth Certificate (EBC)

GRITS Case management requires exposed infants to receive hepatitis vaccines on schedule State law requires reporting to GRITS (IIS) Perinatal module allows for automatic search of immunization records Less burdensome on local HD Fewer transcription errors Avoids data entry redundancy

Provides district coordinator/case manager with a quick view of progress Includes: view of caseload links to perinatal event vaccination status Infant serology test results Flags overdue vaccinations and serology tests Case Management Screen

Pending Features

Alerts case manager/coordinator if EBC indicates Hepatitis B maternal infection Hepatitis B immunoglobulin (HBIG) given HD contacts birth hospital Infection Control to verify mother’s hepatitis B status Increases identification of positive mothers and exposed infants EBC and Follow-up Features

Use perinatal module to track household and sexual contacts to infected mother EBC will collect father's information EBC will collect mother’s previous birth information Link to case report if contact has infection Search GRITS to identify contact’s vaccination status Case Contacts Feature

For each event, prepopulated standardized letters and faxes for: Hepatitis B Infected Pregnant Women OB Providers Pediatric Providers Hospitals (L&D) Educational materials and Pediatric/OB poster available for printing from the case management screen Link to Georgia's Perinatal Hepatitis B Prevention Program Website available on case management screen Functional Materials

Thank You Michelle Conner Alex Cowell Tracy Culbreath Tracy Kavanaugh Anil Mangla Lynne Mercedes Elizabeth Sullivan Ebony Thomas Rebecca Willis Patricka Wood

Contact Information Kathryn Spruit, RN, MSN Karl Soetebier, MAPW