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 interoperability EHDI interoperability capability maturity model

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 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 Hearing Screen Birth Pass 1 Month No Hearing Loss Fail Audiologic Exam Pass No Hearing Loss Fail Early Intervention 3 Months6 Months Goal: Sources: Joint Committee on Infant Hearing (JCIH); Centers for Medicare & Medicaid Services (CMS) 2014 Clinical Quality Measure: % screened for hearing loss before hospital discharge

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

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

PHII.org IHE EHDI Profile (CCD)

PHII.org

Performance Improvement Tool Adapted from C4ISR AWG Architectures Working Group, Department of Defense Levels of Information Systems Interoperability (LISI). Washington, D.C.: United States Department of Defense. Interoperability Workflow Policies Infrastructure Data & Standards Receiving notices Sending care plans De-duplicating events Informatics strategy Data sharing agreements Privacy, confidentiality Workforce HIE IT Architecture HL7 SNOMED, LOINC IHE

PHII.org Capability Maturity Model 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. Level 0 None Level 1 Initial Level 2 Managed Level 3 Defined Level 4 Measured Level 5 Optimized No awareness or efforts Isolated, ad-hoc efforts; Individual heroics Repeat early successes; Begin to establish processes Routine processes, documented procedures; Established governance, policies Evaluation of procedures, processes Use evaluation results to improve

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

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

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