1. Public Health Data Standards Consortium http://www.phdsc.org http://www.phdsc.org

2. Public Health Data Standards Consortium CDA EHDI Pilot Project Clinical Document Architecture (CDA) for Public Health CDA State EHDI Pilot Projects

3. PHDSC Pilot Goal Enable standardization of Early Hearing Detection and Intervention (EHDI)-related information exchanges for State EHDI Programs develop and test interoperability standards for HIT products used in EHDI information exchanges deploy standards-based HIT solutions in State EHDI Programs

4. General Use Case Scenario

5. CDA EHDI Pilot Project: State-Specific Use Case 1.Child is delivered. 2.Clinician conducts initial physical exam 3.Newborn is due for 4.Clinician orders an 5.Hospital staff conducts 6.Hospital staff enter data on the in the EHR database and generate 7.Information is electronically sent on to the PH EHDI IS directly or via HIE 8.PH program EHDI IS receives Notification of Report Availability 9.PH programs’ staff reviews the report and create PH EHDI IS record on a child in PH EHDI IS and upload in PH EHDI IS 10.PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. Use Case Actors: Business Actors Technical Actors Flow of Events Data Categories 1&2. Demographics, Labor & Delivery Record, Newborn EHR 3. Consent 4. Standing Order 5. Hearing Test Results 6. Hearing Test Results, NHS Outcome Report 7. NHS Outcome Report 8. Notification of Report Availability 9. Updated Pubic Health EHDI Record 10. Acknowledgement of Receipt Newborn Hearing Screening Newborn, Caregiver, Clinicians, Public Health Program Staff EHR, HIE, Public Health (PH) EHDI IS Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

6. Technical Architecture Options

7. Public Health Gateway CDA NHS Outcome Report Birthing Facility EHR (Epic 2012) Continuity of Care Document (CCD) State EHDI Information System (Orion Rhapsody, Locally Developed) CDA-based Actor Diagram using IHE RFD Oregon - EHDI Reporting Design – Option #1 Use Form Manager to collect/send data Form Filler Form Manager Continuity of Care Document (CCD) Or Other CDA Document (Labor & Delivery Summary) Form Receiver Form Delivery of Form along with pre- population data bound to the form

8. Birthing Facility EHR (Epic 2012) State EHDI Information System (Orion Rhapsody, Locally Developed) Oregon - EHDI Reporting Design – Option #2 Send CDA directly from EHR to EHDI IS CDA NHS Outcome Report CDA – HL7 Clinical Document Architecture NHS – Newborn Hearing Screening EHDI – Early Hearing Detection & Intervention

9. Public Health Gateway (OZ) CDA NHS Outcome Report (internal) Birthing Facility EHR (Cerner) Continuity of Care Document (CCD) State EHDI Information System (OZ) CDA-based Actor Diagram using RFD North Dakota - EHDI Reporting Design Form Filler Form Manager Continuity of Care Document (CCD) Or Other CDA Document (Labor & Delivery Summary) Form Receiver Form Delivery of Form along with pre-population data bound to the form PCP/ Pedia- trician (Greenway) Care Plan Document Reliable Interchange (XDR) CDA-based Actor Diagram using XDR

10. Birthing Facility EHR (Epic 2012) State EHDI Information System (Orion Rhapsody, Locally Developed) Custom OHSU Reporting Design – Option #2b Send CDA directly from EHR to EHDI IS CDA NHS Outcome Report CDA – HL7 Clinical Document Architecture NHS – Newborn Hearing Screening EHDI – Early Hearing Detection & Intervention OHSU Interface We would monitor our existing outbound ADT interface from Epic. For newborns, the interface engine would fetch the additional hearing data from Epic's FSD database. The interface engine would add the hearing data to the message and map the whole thing onto Lisa's EHDI CDA. This message would go straight to the State of Oregon in EHDI CDA format.

11. Newborn Hearing Screening Data Model

12. Newborn Hearing Screening Results - Data Model Subset of Early Hearing Care Plan (EHCP) Header Hearing Screening Coded Results Procedure Information Test Results – Left Ear Procedure Information Test Results – Right Ear Procedure Information

13. Addressed by Early Hearing Care Plan RecordTarget DocumentationOf/SerivceEvent InformationRecipient RecordTarget/guardian RecordTarget/patientRole/id RecordTarget/languageCommunication RecordTarget/patientRole/organization Newborn Hearing Screening Procedures Newborn Hearing Screening Results NHS CDA Document Perspective Header Body

14. Project Tasks, Timeline, Status

15.  Recruitment: Aug – Sept ✔  2 State participants – ND and OR  State observers  Pilot Design: November – December 2012 ✔  Implementation: January - February 2012 ✔  Testing: February – March 2012   Connectathon – Feb 1, 2013  Field (sample data) – Feb 28, 2013  Operational (patient data) – March 14, 2013  Final Report: March - May 2013  Draft Project Report  Final Project Report – May 2013 CDA EHDI Pilot Project: Timeframe for ND

16.  Recruitment: Aug – Sept ✔  2 State participants – ND and OR  State observers  Pilot Design: November – February 2012   Implementation/Partner Level Testing: March – April 2012  Full Test: April 2012  Field (sample data)  Operational (patient data)  Final Report: May 2013  Draft Project Report – April 2013  Final Project Report – May 2013 CDA EHDI Pilot Project: Timeframe for OR

17. NORTH DAKOTA Finalize recruitment of Greenway partners – 2/8 Finalize work plan – 2/8 CDA EHDI Pilot Project: Next Steps

18. OREGON Finalize reporting architecture – 2/22 Confirm system ability to send data – 2/22 Finalize work plan – 2/22 CDA EHDI Pilot Project: Next Steps

19. PARTICIPANTS FOR NEXT PILOT Start recruitment of vendor partners Confirm NHS/EHCP data meets EHDI reqs Confirm system ability to send data Review architectures for reporting CDA EHDI Pilot Project: Next Steps

20. References

21. Glossary CCD – HL7 Continuity of Care Document CDA – HL7 Clinical Document Architecture EHCP – IHE Early Hearing Care Plan HL7 – Health Level 7 IHE – Integrating the Healthcare Enterprise NHS – Newborn Hearing Screening RFD – IHE Retrieve Form for Data Capture

22. Questions? CDA EHDI Pilot Project