1. Shan He, PhD Intermountain Healthcare
Implementing Automated Data Reporting to Improve Early Hearing Care
S116: Methods for Enhancing Public Health Surveillance with EHR Data
Shan He, PhD
Intermountain Healthcare

2. Disclosure
I have no relevant relationships with commercial interests to disclose.
AMIA | amia.org

3. Introduction
Hearing loss is one of the most common birth defects (1 out of 300 babies)
The first months and years of life are a critical period for brain development.
Early identification of hearing loss and appropriate intervention ensures a child will have the opportunity to reach their maximum potential
source:
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4. Early Hearing Detection and Intervention (EHDI)
LTD
Public Health
Healthcare Provider
Test for congenital
CMV
Child
Birth
Newborn Hearing Screening
Repeat Hearing Screening
Discharge
Outpatient
Hearing
Screening
fail
fail
fail
LFU
Diagnostic
Hearing Evaluation
Day 1
Day 2
Day 3
Day 14
Day 21
3 months
LFU: loss to follow-up; LTD: loss to documentation
AMIA | amia.org

5. Background
2014 Annual EHDI data indicate about 34% of infants were considered as LFU/LTD1
Utah: 13% of infants were considered as LFU/LTD
1Source: Summary of Diagnosis and Loss to Follow-up / Loss to Documentation in
AMIA | amia.org

6. Objective
Enable real-time, electronic diagnostic hearing data reporting to the State EHDI program
Implement a solution with low budget by leveraging existing Health Information Exchange (HIE) infrastructure
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7. Methods
Develop decision support rules to capture the diagnostic evaluation event in real-time
Generate a standard C-CDA document with embedded diagnostic evaluation report and lab results
Send the C-CDA document to the State EHDI program using Direct
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8. Data Flow Overview
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9. Decision Support Triggers1 2 3
Decision Support Triggers
Data-driven
Storage of a CMV lab result
Finalized documentation of a diagnostic evaluation report
Audiology Assessment/Reassessment
Audiology Audiogram Report, Pediatric
Audiology External Medical Information, Pediatric
Audiology Auditory Brainstem Response Report, Pediatric
Audiology Assessment
Audiology Consult
Audiology Evaluation Report, Pediatric
Audiology Oto Acoustic Emissions Report, Pediatric
Audiology Initial Evaluation Report
Audiology Progress Report, Pediatric
Audiology Initial Evaluation Report, Pediatric
Audiology Tympanogram Report, Pediatric
Cytomegalovirus DNA [Presence] in Unspecified specimen by Probe & target amplification method
5000-5
Cytomegalovirus IgG Ab [Units/volume] in Serum by Immunoassay
5124-3
Cytomegalovirus IgM Ab [Units/volume] in Serum by Immunoassay
5126-8
Cytomegalovirus DNA [Units/volume] (viral load) in Plasma by Probe and target amplification method
Cytomegalovirus DNA [#/volume] (viral load) in Unspecified specimen by Probe & target amplification method
Cytomegalovirus DNA [Log #/volume] (viral load) in Unspecified specimen by Probe & target amplification method
Cytomegalovirus DNA [Units/volume] (viral load) in Unspecified specimen by Probe and target amplification method
Cytomegalovirus
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10. C-CDA Generation 1 2 3 Why C-CDA Progress Note
Industrial standard for document-based health information exchange
Existing C-CDA implementation infrastructure in place at Intermountain
Progress Note is clinically suitable
The C-CDA Progress Note can accommodate all information for this use case without requiring other irrelevant data types
Assessment and Plan section—diagnostic report as image
Results section—CMV lab results
AMIA | amia.org

11. Embedded free-text report in C-CDA
Identification of the CDA-R2 syntax and finding a way to present the JPEG information in the CDA document ( a simpler, standard one-step rendering process)
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12. Document Transport 1 2 3 Direct Secure, easy-to-use, inexpensive
Existing Direct infrastructure implemented at Intermountain
A Direct address was provisioned for EHDI by the state HIE
Content sent as XML and rendered in human readable format
Easy to parse, ready to be integrated with the HiTrack system as the next step
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13. Results
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14. Results
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15. Results Timeframe: 10/01/2016—09/30/2017
4,421 C-CDA documents sent from Intermountain to UDOH
2,236 unique patients
7% (158/2,236) of patients have both CMV and Audiological Note triggered C-CDA documents
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16. Results
Number of C-CDA documents
Month
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17. Results
Number of C-CDA documents
Age Group
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18. Results Frequency Number of C-CDA Hearing Documents per Patient
About half of the patients have had more than one diagnostic event in one year.
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19. Outcome/benefits
Reduced the LTD rate to near zero for Intermountain facilities
from 12 reports/month (fax) to 368 reports/month (electronic)
Decrease in LTD will impact the LFU, which in turn impacts early identification
Faster intervention possible from EHDI
Utah EHDI Program was able to quickly identify a child that received the wrong CMV test and contact the Primary Care Provider to conduct the right test within the 21 day time frame for proper treatment
AMIA | amia.org

20. Limitations
Non-structured data for the diagnostic audiology notes in C-CDA
IHE Early Hearing Care Plan (EHCP) Profile under development
Disconnection between the C-CDA documents received via Direct and the HiTrack system
Lack of a formal evaluation of the completeness and timeliness of the electronic reporting
AMIA | amia.org

21. Yesterday… Public Health Healthcare Provider
LTD
Public Health
Healthcare Provider
Test for congenital
CMV
Child
Birth
Newborn Hearing Screening
Repeat Hearing Screening
Discharge
Outpatient
Hearing
Screening
fail
fail
fail
LFU
Diagnostic
Hearing Evaluation
Day 1
Day 2
Day 3
Day 14
Day 21
3 months
LFU: loss to follow-up; LTD: loss to documentation
AMIA | amia.org

22. Today… Public Health Healthcare Provider Test for congenital CMV Child
Birth
Newborn Hearing Screening
Repeat Hearing Screening
Discharge
Outpatient
Hearing
Screening
fail
fail
fail
LFU
Diagnostic
Hearing Evaluation
Day 1
Day 2
Day 3
Day 14
Day 21
3 months
AMIA | amia.org

23. Tomorrow… Public Health Healthcare Provider Test for congenital CMV
Child
Birth
Newborn Hearing Screening
Repeat Hearing Screening
Discharge
Outpatient
Hearing
Screening
fail
fail
fail
LFU
Diagnostic
Hearing Evaluation
Day 1
Day 2
Day 3
Day 14
Day 21
3 months
AMIA | amia.org

24. Acknowledgement
Sidney N. Thornton, PhD, Intermountain Healthcare Darren Mann, Intermountain Healthcare Christine Perfili, MBA, Utah Department of Health Krysta Badger, Utah Department of Health Matt Hoffman, MD, Utah Health Information Network Viral Shah, Intermountain Healthcare Gary Anderson, Intermountain Healthcare Rishabh Bhatia, Intermountain Healthcare
AMIA | amia.org

25. Thank you!