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John Eichwald, Team Lead
Early Hearing Detection and Intervention (EHDI)
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention (CDC)
Public Health Data Standards Consortium
2012 Annual Business Meeting
November 9, 2012
Hyattsville MD
EHDI CDA Pilot Project
Newborn Hearing Screening
• U.S. Preventive Services Task Force (USPSTF)
recommends screening for hearing loss in all
newborn infants (Grade B - July 2008)
• Hearing loss is one of the core newborn
conditions on the Recommended Uniform
Screening Panel (RUSP) of the Secretary’s
Advisory Committee on Heritable Disorders in
Newborns and Children (SACHDNC)
Conditions Screened in the Newborn
About 12,500 infants are diagnosed with the core conditions each year with the current RUSP• Estimated annual numbers (the most common)
– Hearing Loss: 5,064
– Primary Congenital Hypothyroidism: 2,156
– Sickle Cell Disease: 1,775
– Cystic Fibrosis: 1,248
– MCADD : 239
CDC Grand Rounds - Newborn Screening and Improved OutcomesMorbidity and Mortality Weekly Report (MMWR) June 1, 2012
“1 – 3 – 6” EHDI Foundation
Healthy People 2020Hearing and Other Sensory or Communication Disorders
1
Screen no later than 1 month
3
Diagnose no later than 3 months
6
Intervene no later than 6 months
Two types of screening technologies• Otoacoustic Emissions (OAE)• Auditory Brainstem Response (ABR)
Screening
Photographs courtesy of the National Center for Hearing Assessment and Management (NCHAM)
EHDI Clinical Quality MeasureCMS Electronic Health Record (EHR) Incentive Program: Stage 2Final Rule published August 23, 2012
HL7 Messaging Screening Results OBR|17|128993^ST ELSEWHERE HOSPITAL^9999999999^NPI|999555^TNSPHLAB^77D7777777^CLIA |54111-0 ^Newborn hearing loss panel^LN|||201010141853|||^VH||||201010151121||1111111111^Smiles^Minnie^^^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^^^^^^^^MD||||||201010160918|||FOBX|1|TX|57700-7^Hearing loss newborn screening comment/discussion^LN||Any baby with clinical features suggestive of hearing loss requires clinical and diagnostic follow-up regardless of whether the NMS result is normal or abnormal.|||N|||FOBX|2|CE|54109-4^Newborn hearing screen – right ^LN||LA103921^Pass^LN|||N|||FOBX|3|CE|54108-6^Newborn hearing screen – left ^LN||LA103921^Pass^LN|||N|||FOBX|4|CE|54106-0^Newborn hearing screen method^LN||LA10388-9^Auditory brain stem response^LN|||N|||F
Implementation Guide for Laboratory Results, U.S. Realm, HL7 Version 2.5.1
EHDI CDA Pilot Project
• The HIT Standards Federal Advisory Committee has
recommended the use of the HL7 CDA standard as a
future direction for electronic data exchanges between
clinical and public health information systems for public
health reporting
• The Public Health Data Standards Consortium (PHDSC) is
demonstrating electronic data exchange between clinical
EHR Systems and public health EHDI using the HL7 Clinical
Document Architecture (CDA) standard
EHDI CDA Pilot ProjectGoal: demonstrate the ability to receive a CDA-based EHDI Report by a Public Health Information System in two jurisdictionswill focus on reporting of:
• Newborn hearing screening results and basic patient demographics from the birthing facility’s EHR to the State EHDI Program
or• Early Hearing Care Plan (EHCP) - based on
jurisdictional plans
Health Information Exchange
(HIE)
Or
Public Health
Gateway
Birthing Facility
EHR
Screening Results
Document State EHDIInformation
System
CDA-based Actor Diagram
CDA EHDI Pilot Project DesignProposed Public Health Reporting Schema: Screening Report
Screening Results
Document
Health Information Exchange
(HIE)
Or
Public Health
Gateway
State EHDIInformation
System
Early Hearing
CarePlan Primary Care
Provider EHR
CDA-based Actor Diagram
CDA EHDI Pilot Project DesignProposed Public Health Reporting Schema: Care Plan
Early Hearing
Care Plan
TEAM
2 States Participants: (to be determined)• Maryland, Massachusetts, Michigan, North
Dakota, Oregon, Rhode Island
States Observers• Florida, Missouri, Ohio, Pennsylvania, South
Carolina, Texas, Washington
PHDSC Team:• Alla Fridman, Anna Orlova, Lisa Nelson, Lori
Fourquet, Maiko Minami, Sarah Quaynor
CDA EHDI Pilot Project: Team
• Aug - Sept– Recruitment• 2 State participants (To be determined)• X State observers
• November 2012 – Pilot Design• December 2012 – Implementation• January 10, 2012 – Testing• February, 2013 – Draft Project Report• May 2013 – Final Project Report
CDA EHDI Pilot Project: Timeframe