Extending Our Reach Through Partnerships June 2-6, 2013 Phoenix, Arizona

Advancing e-Birth Records: Minnesota’s Experience Kari Guida, MPH, MHI Senior Health Informatician Minnesota Department of Health

Acknowledgements Unity Hospital: Cheri Clough, Marcia Hauck, Stacy Hanson, Lori Wightman, Maggie Borer CDC/NCHS: Michelle Williamson, Delton Atkinson MN.IT: Otto Hiller, Naz Hamdan, Brenda Gabriel, Kathy Grantham MDH: Steven Elkins, Martin LaVenture, Behnoush (Sidney) Salehi, Sally Almond, Cindy Coleman, Cheri Denardo, Jennifer Fritz, Priya Rajamani, Heidi Granlund

Topics Study Overview: Background, Approach & Methods Preliminary Findings & Observations Discussion Next Steps

Study Overview Evaluate the readiness for secure electronic exchange of birth records information from hospitals’ EHR to the Minnesota Department of Health (MDH) Integrating the Healthcare Enterprise (IHE) Birth and Fetal Death Reporting (BFDR) Profile Health Level 7 (HL7) standard message and document specifications Make recommendations MDH, hospitals, NCHS and partners regarding standards-based exchange of birth record information. September 2012 – December 2013

Study Background The Minnesota Registration & Certification System (MR&C), a web-based system for vital records and certificate issuance was implemented in Gaps and needs identified: Quality of the data and workflow efficiencies Interoperability between the state and hospitals’ EHRs during the abstraction and exchange. Most (96%) of Minnesota hospitals have an EHR.

EHR Vendors by Minnesota Birth Hospitals and Births (2012) EHR Vendor # of Birth Hospitals % of Birth Hospitals # of Births% of Births Epic4241%45,29867% Meditech2222%5,1058% McKesson1010%8,72413% Other2827%8,09213% Total102 67,219 Minnesota Department of Health, Office of Health Information Technology, AHA Annual Survey (2012) Response Rate: 92% (136 of 148)

e-Birth Records Approach: Partnerships Established a Collaborative Team Office of Vital Records, Office of Health Information Technology, MN.IT at MDH and CDC/NCHS project manager, business/program experts, information technology experts, health informaticians and project sponsors Fostered Stakeholder Engagement Partner Hospital Advisory Group (MN e-Vital Records) Community of Interest Ongoing outreach to MDH, EHR/HIT vendors, and others

Overview of Study Methods MethodsProcesses, Strategies and Outcomes Analyze Information, Technology & Workflow  Describe the birth records process at MDH & hospital.  Compare data sources for the birth records process.  Assess HL7 for transaction of birth record information. Test Proof of Concept  Demonstrate standards-based information flow between partners in the birth records process. Develop & Validate Models  Develop and validate models with stakeholders. Discover Opportunities for Improvement  Identify opportunities for improvements in the information, technology and workflow components.  Develop and compare future state to current state.

Minnesota’s Birth Record Information Flow

Preliminary Results Developing the MN Birth Record Information flow engaged partners and created understanding of significance of the birth records data. The proof of concept achieved mapping of 31 percent of medical data elements from the IHE BFDR Profile to the EHR. Stakeholders are excited for standards-based exchange IHE Connectathon

Unity Hospital’s Current Birth Record Process

Preliminary Results Analysis of the partner hospital’s birth records process identified multiple challenges including: duplicate data entry medical information captured in text fields, discrete fields and scanned documents time and effort to obtain birth data from multiple electronic and paper sources lack of integration of prenatal care data into the EHR Integration of prenatal care data into the EHR is influenced by: relationship between prenatal care provider and hospital hospital policy and workflow

Examples of Variations between Data Sources Data Source Facility Worksheet for the Live Birth Certificate (nationally recommended) Birth Certificate Information-Medical Portion (MDH paper form) Type of Variation Question Infections present and/or treated during this pregnancy Infections present/treated Similar question, worded differently Value Set (response) Gonorrhea No difference Value Set (response) Syphilis Value Set (response) Chlamydia Value Set (response) Hepatitis B Value Set (response) Hepatitis C Value Set (response) None of the aboveNone Similar terms with different meanings within a value set Value Set (response) Genital herpes Similar question with different value set (responses) Value Set (response) GBS Value Set (response) HIV Positive Value Set (response) Other Value Set (response) If Other, specify

Discussion Address variations of all data sources for birth information is critical. Implementation of the IHE BFDR Profile depends on availability of data, quality of data, and birth records process workflow. The IHE BFDR Profile can increase workflow efficiency and improve data quality, but review by hospital staff is necessary.

Discussion Achieving complete mapping of the IHE BFDR Profile data elements to the EHR is essential. States and hospitals need technical assistance and resources for workflow, policy, information technology, organizational/leadership, data quality and informatics. Collaboration between federal and state government, hospitals and EHR/HIT vendors is key to achieving standards-based exchange of birth records.

Study Next Steps Reconcile variation between data sources. Assess MDH’s & Unity Hospital’s readiness for HL7 standards. Develop a model of future standards-based exchange of birth records for both MDH and hospital. Make recommendations to MDH, hospitals, NCHS and partners for standards-based exchange of birth record information

Important Steps to Advance e-Birth Records Nationwide Create a “Roadmap for Implementation” for states and hospitals. Develop toolkits, tips and templates to address training, organizational and technical issues. Grow the understanding of need and opportunity for standards-based exchange for birth records.

Important Steps to Advance e-Birth Records Nationwide Support pilot projects of standards-based exchange between states and hospitals, using IHE BFDR Profile and HL7. Advance and support national and state e-vital records workgroups and/or advisory groups. Engage additional EHR and HIT vendors. Support vital records inclusion into Meaningful Use Stages 3 and beyond.

Contact Information Kari Guida, MPH, MHI Senior Health Informatician Minnesota Department of Health health/index.html