IMPROVING QUALTY OF CARE FOR CHILDREN TROUGH HEALTH IT Tennessee Project for Children with Special Health Care Needs AHRQ Annual Meeting September 26,2007 Carmen B. Lozzio, MD, FACMG Brent Shelton, PhD Rosalyn Lemak MPH, Billy R Hancock, Billy R Hancock, Robert Eubanks, MS and Michelle Liao, MS University of Tennessee-Graduate School of Medicine, Knoxville, TN University of Tennessee-Graduate School of Medicine, Knoxville, TN Department of Medical Genetics, Univ. of Tennessee, Graduate School of Medicine, Knoxville, TN

IMPROVING QUALITY CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS Agency for Healthcare Research and Quality (AHRQ) TRANSFORMING HEALTHCARE QUALITY THROUGH INFORMATION TECHNOLOGY (THQIT) 2004-Planning Grant :Implementation grant

GOALS OF THE PROJECT Improve quality of health care for CSHCN by summarizing all relevant information in an electronic health record called TN Child Health Profile (TN-CHP) Improve quality of health care for CSHCN by summarizing all relevant information in an electronic health record called TN Child Health Profile (TN-CHP) Expand HIT by linking public health databases with genetic, developmental and educational data on each child Expand HIT by linking public health databases with genetic, developmental and educational data on each child Make available to providers and parents/legal guardians a secure, web based TN-CHP Make available to providers and parents/legal guardians a secure, web based TN-CHP

2001/03- HRSA Planning grant: one of 22 grants awarded to states, the only one for close collaboration between TN Dept of Health and academic Genetic Centers. 2001/03- HRSA Planning grant: one of 22 grants awarded to states, the only one for close collaboration between TN Dept of Health and academic Genetic Centers. 2003/07- HRSA Implementation grant as one of five states awarded grants for Joint Program Initiative (Collaboration: Genetic Services Branch & Office of Data Integration and Management). 2003/07- HRSA Implementation grant as one of five states awarded grants for Joint Program Initiative (Collaboration: Genetic Services Branch & Office of Data Integration and Management) AHRQ Planning grant: one of 38 grants awarded. One thousands letters of intend submitted 2004-AHRQ Planning grant: one of 38 grants awarded. One thousands letters of intend submitted 2005-AHRQ Implementation grant: one of 16 grants to use e-health to improve quality and safety of medical care. The only one for genetic services AHRQ Implementation grant: one of 16 grants to use e-health to improve quality and safety of medical care. The only one for genetic services SERGG/HRSA: Mini-grants awarded to collaborate with other states in the Southeast region SERGG/HRSA: Mini-grants awarded to collaborate with other states in the Southeast region. TN grants for Genetics and Health Information Technology

Tennessee Genetics Plan for follow-up of NBS/NHS Tennessee developed the Tennessee Genetics Plan in close collaboration of the Tennessee Department of Health, the academic genetic centers and members of a statewide Genetics Coordinating Committee. Tennessee developed the Tennessee Genetics Plan in close collaboration of the Tennessee Department of Health, the academic genetic centers and members of a statewide Genetics Coordinating Committee. The purpose of this plan is to integrate the information on Newborn Screening (NBS), Newborn Hearing Screening (NHS) and other genetic and developmental services to improve the long term follow-up and care of these children The purpose of this plan is to integrate the information on Newborn Screening (NBS), Newborn Hearing Screening (NHS) and other genetic and developmental services to improve the long term follow-up and care of these children A major accomplishment has been the development of an electronic child health profile: the Tennessee Child Health Profile (TN-CHP) that makes possible to provide information on NBS and NHS in a secure, accessible web format to providers registered with the state A major accomplishment has been the development of an electronic child health profile: the Tennessee Child Health Profile (TN-CHP) that makes possible to provide information on NBS and NHS in a secure, accessible web format to providers registered with the state

The Tennessee Child Health Profile (TN-CHP) is a web- based e-health record that condenses the highlights of each child’s medical diagnosis, special needs, and recent services and evaluations into a concise, easy-to-read summary, so that authorized providers can quickly determine appropriate next steps. In addition, parents who opt to have their children included in the system will be able to view their children’s profiles online. The Tennessee Child Health Profile (TN-CHP) is a web- based e-health record that condenses the highlights of each child’s medical diagnosis, special needs, and recent services and evaluations into a concise, easy-to-read summary, so that authorized providers can quickly determine appropriate next steps. In addition, parents who opt to have their children included in the system will be able to view their children’s profiles online.

TN-CHP GOALS: Improve health care delivery, coordination of services, continuity of care and timeliness of follow-up Improve health care delivery, coordination of services, continuity of care and timeliness of follow-up Provide comprehensive medical, Provide comprehensive medical, developmental and case management data from a single secure website Allow long term tracking and avoid “lost” cases Allow long term tracking and avoid “lost” cases

Participating Institutions UT Graduate School of Medicine-Knoxville, Department of Medical Genetics UT Graduate School of Medicine-Knoxville, Department of Medical Genetics Memorial Hospital/UHS, Department of Information Service, Knoxville Memorial Hospital/UHS, Department of Information Service, Knoxville Vanderbilt University Department of Pediatrics -Genetic Center, Center for Child Development Vanderbilt University Department of Pediatrics -Genetic Center, Center for Child Development UT Health Sciences Center (Memphis) UT Health Sciences Center (Memphis) Boling Center for Developmental Disabilities and Genetic Center

Additional Collaborations Tennessee Department of Health Tennessee Department of Health Vanderbilt e-Health Initiative Vanderbilt e-Health Initiative HRSA- Regional Grant: SERGG HRSA- Regional Grant: SERGG Connections Community of Practice- Public Health Informatics Institute Connections Community of Practice- Public Health Informatics Institute AHRQ-Resource Center AHRQ-Resource Center

TN-CHP Pilot Phase 1 Newborn Hearing Screening (NHS) Newborn Hearing Screening (NHS) Newborn Hearing Screening (NHS) Newborn Hearing Screening (NHS)

TN-CHP Pilot Phase 2 in East TN

Statewide implementation of Tennessee Child Health Profile (TN-CHP)

Ultimate Proposed Data Linkage/Sharing Scheme Ultimate Proposed Data Linkage/Sharing Scheme

URL for TN-CHP DEMO Default.aspx

Identifiers to search NBS/NHS data TDH number TDH number Mother Social Security number Mother Social Security number Mother last and first name, date of birth and county of birth Mother last and first name, date of birth and county of birth

Short Term Follow-up of presumptive positive results A summary of evaluations and diagnostic tests performed at the comprehensive genetic metabolic centers, sickle cell centers or pediatric endocrinologists is shown by clicking on the box : Confirmatory Test

Click on Confirmatory Test Click on Confirmatory Test

Link Diagnosis to Resources For MCAD the following resources are linked to this diagnosis =mediumchainacylcoenzymeadehydrog enasedeficiency =mediumchainacylcoenzymeadehydrog enasedeficiency descriptions/mcad.php

Example of abnormal newborn hearing screening results After state report go to search page and click on Hearing Follow-up (interactive page for provider to record reports)

For educational information on Hearing Loss Go to home page and click on Newborn Hearing Screening

For information on long term follow-up of confirmed diagnosis Go to Home page and click on Child Data Child Data (this information requires parental consent)

Short and medium term outcomes Confirmed diagnosis is established and treatment is started as soon as possible Confirmed diagnosis is established and treatment is started as soon as possible Infants with confirmed diagnosis are followed and treated by the appropriate specialist based on the diagnosis (metabolic geneticist, hematologist or endocrinologist) and follow-up information is reported back to the primary care physician and to the other specialists involved in the care of the child. Infants with confirmed diagnosis are followed and treated by the appropriate specialist based on the diagnosis (metabolic geneticist, hematologist or endocrinologist) and follow-up information is reported back to the primary care physician and to the other specialists involved in the care of the child. Infants with confirmed diagnosis have a medical home that coordinates care with the specialists and with other resources in the community beginning as soon as possible within the first year of life. Infants with confirmed diagnosis have a medical home that coordinates care with the specialists and with other resources in the community beginning as soon as possible within the first year of life.

Long term outcomes Children have received consistent treatment and monitoring of the diagnosed condition and show medical signs of compliance with the treatment. Children have received consistent treatment and monitoring of the diagnosed condition and show medical signs of compliance with the treatment. Prevention of developmental delay and behavioral problems by appropriate treatment measured by psychological and behavioral assessments. Prevention of developmental delay and behavioral problems by appropriate treatment measured by psychological and behavioral assessments. Reduction of known complications such as sepsis or pain crisis in conditions such as sickle cell disease Reduction of known complications such as sepsis or pain crisis in conditions such as sickle cell disease Children with confirmed diagnosed have a consistent medical home and receive early intervention services as needed and are transitioned to educational services as needed. Children with confirmed diagnosed have a consistent medical home and receive early intervention services as needed and are transitioned to educational services as needed.

FUTURE PLANS Offer electronic reporting of NBS and NHS to all physicians and other health care providers registered with the state. Offer electronic reporting of NBS and NHS to all physicians and other health care providers registered with the state. Collaborate and coordinate services with all information exchange programs in the state. Collaborate and coordinate services with all information exchange programs in the state. Link TN-CHP to other TDH databases such as Birth Certificates and other Vital Records, Immunizations, WIC, and lead screening Link TN-CHP to other TDH databases such as Birth Certificates and other Vital Records, Immunizations, WIC, and lead screening Link to other databases: Early Intervention Services, TN Care, BC/BS Share Health Link to other databases: Early Intervention Services, TN Care, BC/BS Share Health

Acknowledgments Project Partners Project Partners Members of the Statewide Genetics Coordinating Committee Members of the Statewide Genetics Coordinating Committee Staff at the Tennessee Departments of Health Staff at the Tennessee Departments of Health Support: Support: HRSA grant U34MC AHRQ grants P20HS and 1-UC1-HS and 1-UC1-HS

Contact Information Carmen B Lozzio, M.D. FACMG Program Director Phone: (865) A website DEMO is under development and can be accessed at: Default.aspx