1. Expending IIS to EHR: Tracking and Reporting Early Hearing Detection and Intervention (EHDI) 42 nd National Immunization Conference Atlanta, GA March 17, 2008 presented by: Zina Kleyman, MS NJIIS Project Manager co-author: Kathryn Perko Aveni, RNC, MPH Research Scientist, EHDI Program

2. NJIIS Overview Operational since 1998 Web enabled since 2002 Official State system since 2004 Populated with electronic birth records (EBC)

3. NJIIS Primary Purposes Provide current recommended immunization schedule for all age groups Consolidate immunization information from all providers into one record to provide an accurate immunization assessment Eliminate the use of manual vaccine administration logs

4. NJIIS Primary Purposes Ensure access to preventive health/screening information such as immunization, Flu, TB, Lead and Newborn Hearing Screening Help communities assess their immunization coverage and identify pockets of need

5. NJIIS Stakeholders Colleges/Universities Health plans Health care providers Schools Day care centers State & Local Health Departments

6. NJIIS Statistics 500Active Healthcare Providers 1,350Vaccines For Children Providers 500Schools 5,000Users 1,260,000Patients 12,000,000 Doses Every month 12,000Patients are loaded from EBC and entered on-line via web 160,000Doses are entered on-line via Web 50,000Doses are loaded electronically from Medicaid, EMR and billing systems

7. NJIIS Overview Technology Components  J2EE for middleware on Weblogic server v8.1  Oracle 9i for database  JSP/HTML for presentation  XML, HL7 and Delimited files for data interfaces with external systems Infrastructure Components  Intel-Xeon platform  Windows 2003 servers

8. Child Health Preventive Programs Immunization Coverage Medical History related to vaccine preventable diseases Lead Screening Early Hearing Detection and Intervention (EHDI) Vaccines For Children (VFC)

9. Early Hearing Detection and Intervention Implemented in September 2006 Available to patients’ primary provider, audiologists and EHDI program Initial screening done at the birth hospital and loaded into NJIIS via EBC Follow-up screening and diagnostic results entered by audiologist and available to the providers Providers can file Lost to Follow-up Provider Reports are available

10. NJ EHDI – History 1977: Law required “evaluation” of newborns for hearing loss 1980: Hospitals sent paper forms to DHSS for babies with risk indicators for hearing loss 1994-1997: Risk indicators & screening results (if done) now reported via EBC

11. NJ EHDI – History 2002: Law required universal newborn screening. Inpatient results & risks reported via EBC, outpatient results on paper form 2002: EHDI database developed using Microsoft Access. EBC records populate database. Paper forms with outpatient test results data entered by DHSS Clerk.

12. NJ EHDI - Statistics 2005 occurrent births (110,836 births): Screened either before d/c or by 1 mo: 99.0% Refer on final inpatient screening: 3.8%* *Over 7500 paper outpatient follow-up reports submitted for 2005 births

13. NJIIS & EHDI Partnership Why: Allow electronic Web-based reporting by providers doing rescreening and diagnostic testing  More timely  Avoid duplicate and cumbersome writing of demographic information  Avoid errors & incomplete reports  Ability to view previous results IIS system already in place – cheaper and easier than building an EHDI Web system Pediatricians can check status of immunizations and hearing in one system

14. Project Timeline Spring-Summer 2006: NJIIS Programming Aug. 2006: Beta testing by EHDI program Sept. 2006:  Inpatient screening results viewable to PCPs  4 audiology facilities volunteered as pilot test sites for entering outpatient results Dec. 2006: Began full roll-out/user training

15. NJ EHDI - Statistics 2007 occurrent births (111,931 births): Screened either before hospital discharge or by 1 mo: 99.3% Refer on final inpatient screening: 3.2%* *Over 6500 electronic outpatient follow-up reports submitted for 2007 births 2005 occurrent births (110,836 births): Screened either before hospital discharge or by 1 mo: 99.0% Refer on final inpatient screening: 3.8%* *Over 7500 paper outpatient follow-up reports submitted for 2005 births

16. NJ EHDI - Statistics Total forms entered in IIS to date (as of 2/6/08) since implementation in 9/06:  Follow-up SCH2: 7495  Lost to follow-up SCH3: 2071 Total forms input in NJIIS in 2007 – 6532  Total forms input by audiologist - 4295  Total forms input by EHDIP staff - 2237 In average, 65% forms entered directly by testers, the remainder data entered by DOH staff from paper. In last 3 months 75% of the forms entered by testers. 52 audiologist actively using the system

17. Provider Setup Address info used to auto fill facility address on reports EHDI data coordinator has admin access to IIS and can add Audiology Facilities

18. Provider Profile Providers identified as Audiological Facility in order to provide special access and security

19. User Setup EHDI data coordinator also can create “EHDI Users”

20. User Groups EHDIP User identifies a person who works at Audiological Facility and can be created by EHDI and NJIIS Admin EHDIP Admin can be created by NJIIS Administrator only

21. User/Provider Setup EHDI Users can be assigned to multiple facilities: practice with several offices, user w/ 2 part-time jobs

22. Provider Choice User starts by selecting the facility they are reporting from (if works at more than one facility)

23. Search - Identifiers User can choose to search with child info, identifiers or mother’s name

24. Patient Information Page EHDI Users can access only certain tabs, e.g. aliases, addresses, but not immunization or Medical History)

25. Relatives/Addresses Alternate guardians can be added. Address/phone number info can be updated

26. Patient Information Page Hearing Screening link is only active for “EHDI Users” and Pediatricians who have “claimed” PCP status for child

27. Audiology Facility of Record EHDI Users are asked to note if they are “primary” audiology follow-up facility for purposes of reports

28. EHDI Summary Page Initially displays risk info and inpatient screening results from EBC Summary of outpatient follow-up is added as forms are completed in the system Buttons at the bottom of the screen are clicked to start a new outpatient follow-up report

29. Clicking an exam date on the summary page opens full report EBC system includes some hearing loss risk indicators

30. Demographic section is auto-filled with information already stored in the NJIIS system Reason for testing also auto-fills Facility name & address is auto-filled based on user login

31. Risk Indicators Pop-up Box

32. Test result sections are mainly radio buttons. Evaluator is pick list of people working at that facility. Phone auto-fills based on phone number stored in user setup

33. Saving form triggers data validation checks: Must have exam date Exam date must be greater then DOB If diagnose is hearing loss then must have type and degree, Etc.

34. Form can be printed after saving (to send copy to pediatrician) DHSS does not require a paper copy

35. EHDI Summary Screen – Pedi User Pediatricians have ability to view results and can generate a “lost to follow- up” form. If doing testing in their office, they must be set up as “EHDI User” type

36. Demographics auto-fill the same as with the follow-up report

37. Both Pediatricians and Audiologists have the ability to run reports for “their” patients

38. Report Sample

39. EHDI program in administrative section can create extract to export data to Excel

40. Summary - Using NJIIS for EHDI Reporting Addition to currently used system allowed a very cost-effective way to incorporate electronic reporting Brings Pediatricians into process End-user friendly  Exactly mimics paper report forms  Summary page allows to access full screening history at any time  Comprehensive reporting for PCP and Audiologists

41. Kathy Aveni Conducting Training Session for Audiologists