State of Florida Newborn Screening presentation to APHL Health IT Workgroup

Florida Newborn Screening ELO / ELR Project

Early Hearing Detection &Intervention (EHDI)

Pulse Oximetry Reporting in Florida

CCHD/HIT Joint Webinar | March 27, 2015

Andrew RichardsonChildren’s Medical Services, Florida Dept of Health

Eduardo Gonzalez LoumietData Integration Project Manager, Uber Operations contractor to the Florida Dept of Health

Speakers Introduction

Florida NBS ELO/ELR Project

Project Summary

• Develop and maintain a bi-directional Electronic Laboratory

Ordering (ELO) and Electronic Laboratory Reporting (ELR)

interface between Florida’s hospital Laboratory Information

Management Systems (LIMS) and the Florida Department of

Health’s Bureau of Laboratories for Newborn Screening (NBS)

tests.

• The project would focus on improving the efficiency and

timeliness of Newborn Screening test result reporting, not

only for the BOL, but also for all Florida hospitals.

• 220,127 births – 2014

• Universal Newborn Hearing Screening (UNHS)

adopted in 2000

• Critical Congenital Heart Disease (CCHD) adopted in

June of 2014

• UNHS reporting history: Aggregate reporting – to

record level reporting on blood card – to web-based

reporting – to HL7 electronic file reporting.

• CCHD reporting history: record level reporting on

blood card – to HL7 electronic file reporting.

Florida’s Historic Profile

Hearing Reporting History• 2001 – 2002 Aggregate data faxed and mailed from hospitals and stored on

spreadsheets.

• 2002 – 2005 – Received child specific information for referred hearing

results, only.

• 2005 – 2013 – Received child specific data for all hearing screening results.

• June 2013 – current – eReports (web portal)

• In progress – HL7

CCHD Reporting History

• January of 2014 – added section on the

blood card for blood card reporting.

• Web portal available for reporting, but not

used.

• HL7 – in progress

Florida Blood Card, Today

• Hearing fields available: Hearing Screening Date,

Right ear result (pass or refer), Right ear test

method (OAE or ABR), Left ear result (pass or

refer), Left ear test method (OAE or ABR), hearing

risk status (multiple can be selected – values

available: PPHN, ECMO, Family History, Birth

Weight less than 1500 grams, exchange transfusion

for hyperbilirubinemia), Not screened reason

(Available options: Baby expired, Missed, Birth

defect, facility transfer, not yet screened NICU,

parent/guardian refused).

• CCHD fields available: pulse oximetry date, test

result (options available: pass, fail, not tested), right

hand oxygenation %, lower extremity oxygenation%.– RH and LE values are the final values recorded after completing the

CCHD screening protocol.

The future:

HL7 Electronic Reporting

Where data is stored

• Pulse Oximetry Data – hospital EMR

• EHDI/Hearing screening data – varies,

some hospital EMR, some hearing

screening provider data system.

– Our experience - more difficult to get from

outsourced hearing screening entities due to

lack of robust data integration team.

How we plan to get the

Hearing and Pulse

Oximetry Data into our

system

Enterprise Data IntegrationFoundations We Build on

• FDOH Data Integration Program started in 1998 as a response to requests for ELR for surveillance systems– Researched available tools

– People are as important as tools – integration is a mindset as well as a skill set. Training is mandatory

– Started with a small implementation but in a framework that would scale

• Pilot project – ELR for STD’s resulted in immediate benefits and gained us support at an Enterprise level

• 15 yrs later and we are processing over – 4 million lab results for surveillance

– 40 million Immunization transactions

– $200 million in HIPAA Compliant Claims for medical services

– 300 files not requiring transformation

– Our 1st year of processing over 1 million lab orders/requests

– And now our latest project Newborn Screening, which leverages knowledge gained over the last 15 years.

Foundation: Infrastructure

Integration Transport

FileMover

Foundation: Tool Belt

Foundation: Standards

PHLIP RnR• All Children's• Labcorp• Mayo

Direct Send• 25 US states• CDC• Quest• SNTC• BBRHIO• Specialty Labs• Cerner• Finlay• Halifax• Sarasota• Clinlab

• Hundreds of trading partners

SFTP

• IRL• Palm Beach County

• Pilot testing

ELR

ELR DB

Merlin (DSS)

• SQL• Surveillance• Palm Beach

IIS

HMS ELO

ELR

HMS (Cache)

67 County HDs

Data Integration Team

• NBS

PRISM STD

Foundation: Experience• ELR in production in 1999

• Public Health Laboratory Interoperability Project (PHLIP)

• Electronic Laboratory Surveillance Message (ELSM) – influenza results to

the CDC

• Electronic Test Order/Result (ETOR) Salmonella – salmonella orders to the

CDC

• ELC HITECH Project – HL7 2.5.1 between SPHL LIMS, providers, SPHA,

and the CDC.

• PHLIP RnR Hub - development and management

• Laboratory Information Management System Interoperability (LIMSi) project

• A strong working relationship with the Newborn Screening area in the

Children’s Medical Services program

• Pandemic Influenza Project between Florida, Texas, Virginia, and the CDC

Standards

Registration Form

Addendum

Challenges Encountered

• Hearing data not in hospital systems,

where we’re getting blood card data set.

• Additional import routine needed for

hearing data.

• Unique identifiers not perfect in hearing

data external to hospitals set. (can

reference UUID of blood card)

Successes Encountered

• Pulse ox data in hospital EHRs

• Cerner RLN – hub concept, simplifying

network connectivity.

• Onboarding information\documentation.

• positive support from hospital NBS staff

involved in the blood card process, after

hearing presentation on this project.

Partnership

Collaboration