Collaboration 0 Centers for Disease Control & Prevention (CDC) 0 National Association for Public Health & Information Systems 0 MDH – Office of Vital Records 0 MDH – Office of Health Information Technology 0 MN.IT – MN office of Information Technology 0 Allina Health 0 Essentia Health 0 Unity Hospital September, 2012 – April, 2014
eVital Records hypothesis Electronically exchange data from the EHR to MR&C This interoperability would: 0 Be more efficient 0 Improve accuracy of data 0 Be more secure 0 Reduce filing delays
First step: Assessment What is the current state of birth registration? 0 Follow process at one hospital 0 Document each step Special thanks to Unity Hospital
Current hospital birth registration process
Initial assessment: current status 0 Inefficient process 0 Manual data entry/transcription 0 Multiple data sources 0 State unable to assess data quality/validity 0 Exposure to extra patient health information
Informatics learning 0 Healthcare Informatics = using technology to improve patient health 0 Interface = a link/where things connect or intersect 0 Interoperability = useful interaction or movement
How? When? Who? The eVital Records Project considered 0 EHR is compiled throughout the patient stay 0 When should the data move? 0 How to make the data useful? 0 What data should transfer?
Our solution: form manager 0 Utilize a form manager to package information 0 Birth registrar will review & forward 0 Filled form sends data to birth record
Informatics learning 3 Needs for interoperability: 0 Standards 0 Data must exist before it can move 0 Ability to send / Ability to accept data
Multiple systems Multiple stand-alone systems 0 Viewed through “portals” 0 Data transcription 0 Scanning as images
Next Step: Test & Demonstrate Proof of Concept demonstrated to several audiences 0 30% data mapped 0 Form Manager received & sent 0 Vital record populated
Positive Feedback Great idea! Innovative! Extend to other things Send everything this way Think about bi-directionality How soon can we implement?
More informatics learning 0 Meaningful Use = an incentive program for electronic health record implementation 0 Payments & fines 0 Rolled out in stages 0 HL7 = Standards 0 Methods 0 Data sets 0 Language
New problem: non-discrete data 0 EHR created for clinician ease of use 0 Narratives 0 “Smart phrases”
What about demographic data? Some things are not in EHR: 0 Mother’s education, place of birth, race 0 Father’s information 0 Child’s name What or who is data source?
Unanswered questions 0 What about updates to EHR? 0 Corrections 0 Lab values, etc. 0 What about bi-directional exchange? 0 Name changes 0 Who owns the data? 0 Right to share it 0 Right to correct it
Competing Resources: 0 Facilities must comply with MU 0 Facilities also converting other systems 0 ICD 9 becomes ICD 10 0 Innovation takes $$ and time 0 MDH has resource conflicts, too
Will it happen? Absolutely OUR VISION: 0 Mother’s worksheet becomes a tablet or kiosk 0 Birth registrar counsels parents re: registration 0 Birth registrar reviews computer form 0 Birth registrar combines demographic record with medical record and submits birth record Birth registrar becomes a specialized duty
Now is not the time eVital records is still (slightly) ahead of its time 0 Other priorities at facilities 0 Other priorities at MDH 0 Lack of federal standards / mandates / funds 0 EHR data availability
Our recommendations 0 Align policies 0 Seek support from ONC 0 Continue expanding & testing 0 Develop informatics-savvy 0 Vital records offices 0 Stakeholders
What does this mean to you? 0 Short term: continue the great work 0 Long term: 0 Improved prenatal clinic to hospital communication 0 Increased structured data in EHR 0 Technology advances for parents’ reporting of demographic data 0 Specialized birth registrars
In summary The eVital Records project is complete 0 Tested electronic exchange of data from EHR to MR&C 0 Documented current process 0 Proposed future process 0 Noted potential barriers