NewSTEPs 360 Application Technical Assistance Webinar - October 6, 2015 Improving Timeliness in Newborn Screening HRSA funded project (Grant No: UG8MC28554)

NewSTEPs 360 Application Technical Assistance Webinar - October 6, 2015Improving Timeliness in Newborn Screening

HRSA funded project (Grant No: UG8MC28554)

All participants are muted upon entry. Please reserve all questions for the Q&A section at the end.• If using computer audio, click on the microphone icon on the bottom left• If joining audio by phone, press*6 to mute/unmute

Zoom Screen

Objectives1. Overview of NewSTEPs3602. Application Process

a. State vs. Group Application (REDCap)b. Budget

c. HIT Funding Opportunity 3. CQI & 5 Whys Approach4. MOUs5. January Kickoff Meeting6. Q & A

Project Overview

NewSTEPs 360 Overview• Goal: to support states through technical

and financial means to achieve timely reporting of results in 95% of newborns that receive a dried-blood spot (DBS) NBS. – At least 20 state NBS programs will receive

quality improvement (QI) training and funding – Will build on the infrastructure of NewSTEPs, an

existing partnership between the Colorado School of Public Health and the Association of Public Health Laboratories

APHL• Jelili Ojodu, MPH• Sikha Singh, MHS, PMP • Careema Yusuf, MPH • Thalia Wood, MPH • Guisou Pinero, MPH • Ruthanne Salsbury

ColoradoSPH• Marci Sontag, PhD • Yvonne Kellar-Guenther, PhD • Joshua Miller, MPH• Sarah McKasson, MPH

NewSTEPs 360

Genetic AllianceNatasha Bonhomme

NICHQShikah Anand, MD,

MPH

March of DimesEdward McCabe,

MD

AMCHPKate Taft, MPH

ASTHOLisa Waddell, MD,

MPH

NCCMike Watson, PhD,

FACMG

OZ SystemsTerese Finitzo, PhD

NBSTRNMike Watson, PhD,

FACMG

Partner in CQI TrainingPartner in Education and Short-term

Follow-up

Application Process

Primary Funding Mechanisms• State Applications: – Individual state NBS programs – $120,000 over three years ($40,000 in Year 1, $50,000 in Year 2,

$30,000 in Year 3)• Group Applications: – Collaborations between states– $140,000 over three years ($40,000 in Year 1, $50,000 in Year 2,

$50,000 in Year 3)

Optional HIT Funding Mechanism

• Order Reporting OZ Application Add-On: – Individual states may choose to apply for $10,000 per year to work

with OZ Systems – Electronic label printing and lab order entry within their programs. – The OZ funding component is optional and independent from the

state and group applications and should NOT be incorporated in the budget request.

ACHDNC Timeliness Recommendations• Presumptive positive results for time-critical conditions should be

communicated immediately to the child’s healthcare provider but no later than the fifth day of life.

• All presumptive positive results for all other conditions should be communicated to the child’s healthcare provider as soon as possible but no later than seven (7) days of life.

• All NBS results should be reported within seven (7) days of life.• Initial NBS specimens should be collected in the appropriate time frame for

the baby’s condition but no later than 48 hours after birth.• NBS specimens should be received at the Laboratory as soon as possible;

ideally within 24 hours of collection.

Focus Areas• Focus Area 1: Developing education in the hospital, birthing facilities, and/or with

midwives (out of hospital births) regarding timely and appropriate collection and shipment of samples.

• Focus Area 2: Identifying and/or strengthening courier system to deliver newborn screening dried blood spots.

• Focus Area 3: Expanding operating hours to provide more uniform coverage for newborn screening throughout the week and across holidays.

• Focus Area 4: Evaluating the efficiency of laboratory processes and/or workflows. • Focus Area 5: Communicating results with provider and clinical specialists and ensuring

timely diagnostic work-up. (Note: If you select Focus Area 5, you must select an additional focus area related to ACHDNC’s recommendations on timeliness).

• Focus Area 6: Using Health Information Technology to improve timeliness through electronic demographic and order submission and result reporting.

Applicant Requirements• State teams must include 5 members / Group teams require 1

representative from each state on the team.• One team member will act as the primary contact for the proposal• In-person meeting January 2016• Engage in CQI activities (monthly calls, coaching, in-person meetings)• Provide monthly timeliness Quality Indicator data (this will require an

MOU signed with NewSTEPs within the first year of funding).• Obtain signatures from:

1. The individual that oversees the NBS program.2. Designated financial signing official for your institution.

How to Apply• All application materials are available at

https://newsteps.org/newsteps-360. • Applications must be completed and submitted

electronically via REDCap. • Interested applicants must contact Joshua Miller (

[email protected]) to receive a unique application link for your team.

HIT Timeliness OptionsIn case HIT wasn’t confusing enough……..

HIT Option 1 – State Application• NBS programs may choose to improve timeliness by

submitting a state application• Focus Area 6: Using Health Information Technology to

improve timeliness through electronic demographic and order submission and result reporting.

• Your goals & objectives for Focus Area 6 can include:1. Development of a system independent of a vendor or in

collaboration with a vendor of your choosing that creates a label and sends the demographic information from the hospitals to the lab.

2. …sends results from the lab to medical providers, PCP’s, etc.3. Prepare your lab for HL7 messaging4. Etc.

HIT Option 2 – Group Application• NBS programs may choose to improve timeliness by

submitting a group application• Focus Area 6: Using Health Information Technology to

improve timeliness through electronic demographic and order submission and result reporting.

• The group application promotes collaboration across states.• The group application may be dedicated entirely to HIT if

you wish. • The application may touch on various aspects of HIT such

as HL7 messaging, creating Lab Order Entries, printing labels, Health Information Exchange, etc.

HIT Option 3 – OZ Systems Application Add-on• NBS programs may choose to improve timeliness by submitting a

state or group application and including the OZ Systems Application add-on.

• OZ Telepathy System:– Will connect to hospitals EHR– Print demographic labels for DBS cards– Prepare the hospital to send HL7 Lab Order Entry message

• $10k/year | Must reapply each year | New states can apply each year

• States can apply for this independent of the LIMS vendor they work with.

• Money goes directly to OZ. OZ works with the hospitals. Provides introductory letter template from NBS program to hospitals.

HIT Options Disclaimer1. The OZ Systems add-on is 100% optional and cannot be applied for independent of the

state and group application. 2. The additional $10,000 for the OZ application is only applicable to the OZ application.3. OZ Telepathy is currently the only commercially available application specifically geared

toward developing a NBS label and sending a NBS lab order entry directly from the hospital.

4. OZ is willing to work with any LIMS vendor to develop systems for HL7 interoperability, and the system is independent from the LIMS systems used within a state (all states can apply for this, independent of their LIMS vendor).

5. NBS programs can apply for funding to improve HIT through a combination of the state application, group application, and OZ add-on.

6. NBS programs may work with any vendor they wish to improve their HIT initiatives. 7. They may also work on HIT initiatives independently (no vendor).

Newborn Dried Bloodspot Screening

Toolkit

NewSTEPS Order Reporting

Application Opportunity

OZ Systems Newborn Screening (NDBS) Order Reporting Application

Individual states may choose to apply for $10,000 per year to begin implementation of OZ Telepathy™ for

STEP 1: Electronic label printing and

STEP 2: Electronic lab ordering. 

OZ Systems extracts data from EHRs for an electronic printed label and an electronic order sent to your state lab.

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Building a NDBS Order Reporting Toolkit with OZ Systems

Your Tools (yes HL7 standards compliant)o Newborn Admission Notification Information (OZ

NANI™)

o OZ Telepathy™ for NDBS

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The OZ Systems Story of Babies & Health Information – Focus on Hospitals

BIRTHING FACILITIESCHILD-CENTRIC SCREENING

INFORMATION SYSTEM FAMILY & PROVIDERS

LABOR & DELIVERY

LABOR & DELIVERY

Newborn Admission Notification InformationOZ NANI

OZ Telepathy

EHDI, CCHD, Bloodspot Screening

Healthcare Facility EHR

DEMOGRAPHICS,ORDER RESULTS

DEMOGRAPHICS,ORDER RESULTS

Newborn Admission Notification Information (OZ NANI™)

• Newborn admission, update and discharge information from EHR in real time to assure screening is completed - on time (HL7 ADTs)

• Accurate, automated denominator of births for screening workflow optimization

• Bolsters patient safety

Our value – your NBS program works with us. We work with your 7 - 200 plus hospitals to get the message right.

OZ Telepathy™ Order Entry Messaging

OZ SYSTEMS

PULSE OX DEVICE

LABS HEARINGSCREENING

PUBLIC HEALTH PROGRAMS

HEALTHCARE ORGANIZATINOS

NANI HL7

NBS Results

EHROZ data

base

Lab

Telepathy NBS

NANI HL7

Specimen Details

HL7

NBS Results w/Specimen Details

Choose your Search Option

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Review and Print

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OZ Systems Newborn Screening (NDBS) Order Reporting Application

1.Verify coverage for all births 2.Verify time of screening3.Nursery workflow support. 4.Reduce manual data entry errors5.Reduce multiple points of data entry6.Audit for QA and shared secure

communications

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OZ Systems Newborn Screening (NDBS)

Focus Area 6: A few ideas• Enhance lab order with specimen tracking captured in the baby’s record. This

works with focus area 2.

• Transmit lab results to our OZ NDBS Screening information system. We disseminate results electronically to providers EHRs. This works with focus area 5.

• If States capture hearing and heart results on the specimen card and hospitals use our hearing and heart screening tools, results could be captured electronically from the screening devices and added to the label specimen card electronically.

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Contact: Terese Finitzo, [email protected]

214-616-4321

Continuous Quality Improvement (CQI) & 5 Whys Approach

Continuous Quality Improvement

• Starting the Process as Part of the Application– Identifying the Problem• The 5 Whys Approach to Find the Root Cause

– Choosing the Focus Area(s) Based on the Root Cause(s) Identified– Choose the Team Based on the Focus Area(s) and Root Cause(s)– Writing SMART Goals and Objectives

5 Whys – A Tool to Identify the Root Cause

5 Whys Steps

1. Gather team and develop problem statement in agreement

2. Ask the first “why”: Why is the problem taking place? Record on flip chart/whiteboard/index cards.

3. Ask four more successive “whys”4. Settle on the most systematic cause.

5 Whys Overview

This becomes your subgoal to move toward your goal. You will write a SMART aim statement for this

Another Way This Might Look –

Problem First Why Second Why Third Why

I weigh 10 pounds more than desired weight

Consuming too many calories

Don’t move much during the day

Eat too many snacks at night

At night I reward myself for a tough day with chocolate

Eat while watching TV and relaxing

Have desk job

Too tired to work out at after work

What might a countermeasure or subgoal look like for this path?

3 Elements to Using Five Whys Effectively

• Accurate and complete statements of the problem

• Complete honesty in answering the questions

• Determination to get to the bottom of the problem and resolving it

Tools to Help

• Videos on Youtube (links are in the Application)

• Appendix A is designed to help you think through the 5 whys– Use it for each “problem” your team identifies

Tips

Choose problems that you think you can have an impact on within the 3 years of funding–Maybe choose a change you can make quickly as well as a change that will take longer

SMART Goals & Objectives

What is SMART?

• Specific• Measurable• Attainable• Results Focused• Time Specific/Time Bound

Another take:What will improve?When will it improve?How much will it improve?For whom will it improve?

Sample SMART Objective

By November 2016, our program will increase the percentage of DBS samples received by the lab within 24 hours from 90% to 95% by providing a courier service to rural hospitals.

• This is specific because we know who (our program) is doing what (increasing the percentage of DBS samples received) and where (at the lab).

• This is measurable because we know the amount of change (90% to 95%).• This is attainable because we know our baseline (90%) and we believe we can achieve

a 5% increase by November 2016. This is based on the resources the program believes they can allot toward this project.

• This is relevant because, based on an assessment of our program, this is an area for improvement, and based on our 5 Whys, the lack of samples received within 24hours from rural hospitals is an issue we need to address to improve timeliness.

• This is time bound because I know our team has to reach 95% by November 2016.

Tools to Help

• Videos on YouTube• Appendix B– Use it for each goal your team identifies

Tips

• We limit you to 3 goals– You may do less– Think through the resources you have to put

towards each goal and the project overall

Memorandum of Understanding (MOU)

Memorandum of Understanding (MOU)• MOUs are part of the NewSTEPs umbrella; between APHL and each

state• MOUs need to be in place by end of Year 1 because of data sharing• Language includes:

– Data ownership– Data sharing– Data reporting– Security language– IRB and OHRP language (attachments to include letters and

applications)• Contact Careema Yusuf for questions ([email protected] or 240-

281-2674)

Kickoff Meeting

January Kickoff Meeting

Tentative Dates: January 21-22, 2015

Place: Washington, DC area (exact place TBD)

Travel costs will be covered for up to 5 team members

Questions?

Contact Information

• Application:Joshua Miller ([email protected] or 303.724.4438)

• OZ System: Terese Finitzo ([email protected] or 214.616.4321)

• MOU Careema Yusuf ([email protected] ; 240.281.2674)