IMPROVING QUALTY OF CARE FOR IMPROVING QUALTY OF CARE FOR CHILDREN TROUGH HEALTH IT CHILDREN TROUGH HEALTH IT Tennessee Project for Children with Special Health Care Needs Tennessee Project for Children with Special Health Care Needs AHRQ Annual Meeting AHRQ Annual Meeting September 26,2007 September 26,2007 Carmen B. Lozzio, MD, FACMG Carmen B. Lozzio, MD, FACMG Brent Shelton, PhD Brent Shelton, PhD Rosalyn Lemak MPH, Rosalyn Lemak MPH, Billy R Hancock, Billy R Hancock, Robert Eubanks, MS and Robert Eubanks, MS and Michelle Liao, MS 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 Department of Medical Genetics, Univ. of Tennessee, Graduate School of Medicine, Knoxville, TN School of Medicine, Knoxville, TN
Transcript
IMPROVING QUALTY OF CARE FOR IMPROVING QUALTY OF CARE FOR CHILDREN TROUGH HEALTH ITCHILDREN TROUGH HEALTH IT
Tennessee Project for Children with Special Health Care Tennessee Project for Children with Special Health Care NeedsNeeds
AHRQ Annual Meeting AHRQ Annual Meeting September 26,2007September 26,2007
Carmen B. Lozzio, MD, FACMGCarmen B. Lozzio, MD, FACMG
Brent Shelton, PhDBrent Shelton, PhD
Rosalyn Lemak MPH,Rosalyn Lemak MPH,
Billy R Hancock, Billy R Hancock,
Robert Eubanks, MS and Robert Eubanks, MS and
Michelle Liao, MSMichelle Liao, MS
University of Tennessee-Graduate School of Medicine, Knoxville, TNUniversity of Tennessee-Graduate School of Medicine, Knoxville, TN
Department of Medical Genetics, Univ. of Tennessee, Graduate Department of Medical Genetics, Univ. of Tennessee, Graduate
School of Medicine, Knoxville, TNSchool of Medicine, Knoxville, TN
IMPROVING QUALITY CARE FOR IMPROVING QUALITY CARE FOR CHILDREN WITH SPECIAL HEALTH CHILDREN WITH SPECIAL HEALTH
CARE NEEDSCARE NEEDS
Agency for Healthcare Research and Agency for Healthcare Research and Quality (AHRQ)Quality (AHRQ)
TRANSFORMING HEALTHCARE QUALITY TRANSFORMING HEALTHCARE QUALITY THROUGH INFORMATION TECHNOLOGY THROUGH INFORMATION TECHNOLOGY
(THQIT)(THQIT)
2004-Planning Grant 2004-Planning Grant
2005-2008:Implementation grant2005-2008:Implementation grant
GOALS OF THE PROJECTGOALS OF THE PROJECT Improve quality of health care for CSHCN Improve quality of health care for CSHCN
by summarizing all relevant information by summarizing all relevant information in an electronic health record called TN in an electronic health record called TN Child Health Profile (TN-CHP)Child Health Profile (TN-CHP)
Expand HIT by linking public health Expand HIT by linking public health databases with genetic, developmental databases with genetic, developmental and educational data on each childand educational data on each child
Make available to providers and Make available to providers and parents/legal guardians a secure, web parents/legal guardians a secure, web based TN-CHPbased TN-CHP
2001/03- HRSA Planning grant:2001/03- HRSA Planning grant: one of 22 grants one of 22 grants awarded to states, the only one for close awarded to states, the only one for close collaboration between TN Dept of Health and collaboration between TN Dept of Health and academic Genetic Centers.academic Genetic Centers.
2003/07- HRSA Implementation grant2003/07- HRSA Implementation grant as one of as one of five states awarded grants for Joint Program five states awarded grants for Joint Program Initiative (Collaboration: Genetic Services Branch Initiative (Collaboration: Genetic Services Branch & Office of Data Integration and Management).& Office of Data Integration and Management).
2004-AHRQ Planning grant: 2004-AHRQ Planning grant: one of 38 grants one of 38 grants awarded. One thousands letters of intend awarded. One thousands letters of intend submitted submitted
2005-AHRQ Implementation grant: 2005-AHRQ Implementation grant: one of 16 one of 16 grants to use e-health to improve quality and grants to use e-health to improve quality and safety of medical care. The only one for genetic safety of medical care. The only one for genetic services.services.
2005-2006-SERGG/HRSA: Mini-grants2005-2006-SERGG/HRSA: Mini-grants awarded to awarded to collaborate with other states in the Southeast collaborate with other states in the Southeast region.region.
TN grants for Genetics and TN grants for Genetics and Health Information TechnologyHealth Information Technology
Tennessee Genetics Plan Tennessee Genetics Plan for follow-up of NBS/NHSfor follow-up of NBS/NHS
Tennessee developed the Tennessee developed the Tennessee Genetics PlanTennessee Genetics Plan in in close collaboration of the Tennessee Department of close collaboration of the Tennessee Department of Health, the academic genetic centers and members of a Health, the academic genetic centers and members of a statewide Genetics Coordinating Committee.statewide Genetics Coordinating Committee.
The The purpose purpose of this plan is to integrate the information of this plan is to integrate the information
on Newborn Screening (NBS), Newborn Hearing Screening on Newborn Screening (NBS), Newborn Hearing Screening (NHS) and other genetic and developmental services to (NHS) and other genetic and developmental services to improve the long term follow-up and care of these improve the long term follow-up and care of these childrenchildren
A major accomplishment has been the development of an A major accomplishment has been the development of an electronic child health profile: electronic child health profile: the Tennessee Child Health the Tennessee Child Health Profile (TN-CHP)Profile (TN-CHP) that makes possible to provide that makes possible to provide information on NBS and NHS in a secure, accessible web information on NBS and NHS in a secure, accessible web format to providers registered with the stateformat to providers registered with the state
The Tennessee Child Health The Tennessee Child Health Profile (TN-CHP) is a web-based Profile (TN-CHP) is a web-based e-health record that condenses e-health record that condenses the highlights of each child’s the highlights of each child’s medical diagnosis, special needs, medical diagnosis, special needs, and recent services and and recent services and evaluations into a concise, easy-evaluations into a concise, easy-to-read summary, so that to-read summary, so that authorized providers can quickly authorized providers can quickly determine appropriate next determine appropriate next steps. In addition, parents who steps. In addition, parents who opt to have their children opt to have their children included in the system will be included in the system will be able to view their children’s able to view their children’s profiles online.profiles online.
TN-CHP GOALS:TN-CHP GOALS: Improve health care delivery, Improve health care delivery,
coordination of services, continuity coordination of services, continuity of care and timeliness of follow-up of care and timeliness of follow-up
Provide comprehensive medical,Provide comprehensive medical,
developmental and case developmental and case management data from a single management data from a single secure websitesecure website
Allow long term tracking and Allow long term tracking and avoid avoid “lost” cases“lost” cases
Participating InstitutionsParticipating Institutions UT Graduate School of Medicine-Knoxville,UT Graduate School of Medicine-Knoxville,
Department of Medical GeneticsDepartment of Medical Genetics
Memorial Hospital/UHSMemorial Hospital/UHS, Department of , Department of Information Service, KnoxvilleInformation Service, Knoxville
Vanderbilt UniversityVanderbilt University Department of Department of Pediatrics -Genetic Center, Center forPediatrics -Genetic Center, Center for Child Child DevelopmentDevelopment
UT Health Sciences Center (Memphis)UT Health Sciences Center (Memphis) Boling Center for Developmental Boling Center for Developmental Disabilities and Genetic CenterDisabilities and Genetic Center
Additional CollaborationsAdditional Collaborations Tennessee Department of HealthTennessee Department of Health
Connections Community of Practice- Connections Community of Practice- Public Health Informatics InstitutePublic Health Informatics Institute
AHRQ-Resource CenterAHRQ-Resource Center
TN-CHP Pilot Phase 1TN-CHP Pilot Phase 1
TN -CHP
-
Newborn Screening (NBS)
Newborn Hearing Screening(NHS)
Repeat screening
Diagnostic tests
Treatment and Follow -up
UTGeneticCenter
CSSCase Managers
Pediatric Endocrinologists
at East TN
Children Hospital
Link
VPN
Link
ParentConsent
SecureWebTN-CHP
-
Newborn Screening (NBS)
Repeat screening
Diagnostic tests
Treatment and Follow-up
-
UT Genetic Center
CSSCase Managers
Pediatric Endocrinologists
at East TN
Children Hospital
Link
VPN
Link
ParentConsent
SecureWeb
Newborn Hearing Screening (NHS)
Newborn Hearing Screening (NHS)
Newborn Hearing Screening (NHS)
TN -CHP
-
Newborn Screening (NBS)
Newborn Hearing Screening(NHS)
Repeat screening
Diagnostic tests
Treatment and Follow -up
UTGeneticCenter
CSSCase Managers
Pediatric Endocrinologists
at East TN
Children Hospital
Link
VPN
Link
ParentConsent
SecureWebTN-CHP
-
Newborn Screening (NBS)
Repeat screening
Diagnostic tests
Treatment and Follow-up
-
UT Genetic Center
CSSCase Managers
Pediatric Endocrinologists
at East TN
Children Hospital
Link
VPN
Link
ParentConsent
SecureWeb
Newborn Hearing Screening (NHS)
TN-CHP Pilot Phase 2TN-CHP Pilot Phase 2in East TNin East TN
TN-CHP
Newborn Screening
Hearing Screening
Birth Certificate
UT Genetic Center
Pediatric Endocrinologists
Other Databases
Acute Care
Hospitals
Local health departments
Pediatricians and Other Providers
Link
VPN
Link
Secure Web
Parent Control
Secure Web
Secure Web
Statewide implementation of Statewide implementation of Tennessee Child Health ProfileTennessee Child Health Profile
(TN-CHP)(TN-CHP)
TN-CHP
Newborn Screening
Hearing Screening
Birth Certificate
Genetics and Sickle Cell Centers
Pediatric Endocrinologists Other
Databases
Acute Care
Hospitals
Local health departments
Pediatricians and Other Providers
Link
VPN
Link
Secure Web
Parent Control
Secure Web
Secure Web
Ultimate Proposed Data Linkage/Sharing Ultimate Proposed Data Linkage/Sharing
SchemeScheme
Linked to :
Linked to :
Common Anchor Data for CSHCN :
.
Electronic BirthCertificate andVital Records
ImmunizationsWIC
EPSDTLead screening
Tennessee Early Intervention
(TEIS)TennCare
Mental Retardation
Genetic and Child Dev. Centers
T -
TN-CHP Comprehensive Child Health Profile-
Volunteer
e-Health Initiative
I
TN-Dept. of Health NBS and NHS
URL for TN-CHP DEMOURL for TN-CHP DEMO
http://gen01/mliao_test2/Default.aspx
Identifiers to search Identifiers to search NBS/NHS dataNBS/NHS data
TDH numberTDH number
Mother Social Security numberMother Social Security number
Mother last and first name, date Mother last and first name, date of birth and county of birthof birth and county of birth
Short Term Follow-up of Short Term Follow-up of presumptive positive resultspresumptive positive results
A summary of evaluations and A summary of evaluations and diagnostic tests performed at the diagnostic tests performed at the comprehensive genetic metabolic comprehensive genetic metabolic centers, sickle cell centers or centers, sickle cell centers or pediatric endocrinologists is shown pediatric endocrinologists is shown by clicking on the box :by clicking on the box :
Confirmatory TestConfirmatory Test
Click on Confirmatory TestClick on Confirmatory Test
Click on Confirmatory Test
Click on Confirmatory Test
Click on Confirmatory Test
Click on Confirmatory Test
Link Diagnosis to ResourcesLink Diagnosis to Resources
For For MCAD MCAD the following the following resources are linked to this resources are linked to this
For information on long For information on long term follow-up of term follow-up of
confirmed diagnosisconfirmed diagnosis
Go to Home page and click onGo to Home page and click on
Child DataChild Data(this information requires (this information requires
parental consent)parental consent)
Short and medium term Short and medium term outcomesoutcomes
Confirmed diagnosisConfirmed diagnosis is established and treatment is is established and treatment is started as soon as possiblestarted as soon as possible
Infants with confirmed diagnosis Infants with confirmed diagnosis are followed and are followed and treated by the appropriate specialisttreated by the appropriate specialist based on the based on the diagnosis (metabolic geneticist, hematologist or diagnosis (metabolic geneticist, hematologist or endocrinologist) and follow-up information is reported endocrinologist) and follow-up information is reported back to the primary care physician and to the other back to the primary care physician and to the other specialists involved in the care of the child. specialists involved in the care of the child.
Infants with confirmed diagnosis Infants with confirmed diagnosis have a medical homehave a medical home that coordinates care with the specialists and with that coordinates care with the specialists and with other resources in the community beginning as soon as other resources in the community beginning as soon as possible within the first year of life. possible within the first year of life.
Long term outcomesLong term outcomes Children have received consistent treatmentChildren have received consistent treatment and and
monitoring of the diagnosed condition and show monitoring of the diagnosed condition and show medical signs of compliance with the treatment.medical signs of compliance with the treatment.
Prevention of developmental delay and behavioral Prevention of developmental delay and behavioral problemsproblems by appropriate treatment measured by by appropriate treatment measured by psychological and behavioral assessmentspsychological and behavioral assessments. .
Reduction of known complicationsReduction of known complications such as sepsis or such as sepsis or pain crisis in conditions such as sickle cell diseasepain crisis in conditions such as sickle cell disease
Children with confirmed diagnosed have a consistent Children with confirmed diagnosed have a consistent medical homemedical home and receive and receive early intervention servicesearly intervention services as needed and are as needed and are transitioned to educational transitioned to educational services as neededservices as needed. .
FUTURE PLANSFUTURE PLANS Offer Offer electronic reporting of NBS and NHSelectronic reporting of NBS and NHS to all to all
physicians and other health care providers physicians and other health care providers registered with the state.registered with the state.
Collaborate and coordinate servicesCollaborate and coordinate services withwith all all information exchange programsinformation exchange programs in the state. in the state.
Link TN-CHP to other TDH databasesLink TN-CHP to other TDH databases such as such as Birth Certificates and other Vital Records, Birth Certificates and other Vital Records, Immunizations, WIC, and lead screeningImmunizations, WIC, and lead screening
Link to other databasesLink to other databases: Early Intervention : Early Intervention Services, TN Care, BC/BS ShareServices, TN Care, BC/BS Share HealthHealth
AcknowledgmentsAcknowledgments Project PartnersProject Partners Members of the Statewide Genetics Members of the Statewide Genetics
Coordinating CommitteeCoordinating Committee Staff at the Tennessee Departments Staff at the Tennessee Departments
