1. Developing web-based heatlh information systems in New Jersey Katherine Hempstead Center for Health Statistics New Jersey Department of Health and Senior Services

2. From paper to the web….  Transition to electronic records occurring throughout the health care system  Benefits to patients, physicians, and government  But many challenges to overcome

3. Three examples 1. Child Health Registry 2. Trauma Registry/Pediatric Critical Care Registry 3. Electronic Death Registration System

4. Child Health Registry  Background Since @ 1999, HRSA and partners have been working to foster development of integrated child health systems Identified key elements Developed principles and core functions Disseminated to states Grant funding

5. Current situation in many states  Separate child health information systems Birth registration Newborn screening Hearing screening Immunizations Birth defects registry Eligibility screenings

6. Problem with current system  Physicians do not receive timely information in many cases  Patients lost to follow up  Leads to under- or over- immunization  Missed opportunities for appropriate care

7. Integration of child health information systems  Goal –  To prevent problems arising from lack of timely, accurate, and complete information  To reinforce concept of a “medical home” for children that contains all information about the child  Facilitate assessment and prompt provision of appropriate services

8. National activities  HRSA and partners  Proposed systematic approach  Developed user requirements  Comprehensive evaluation plan  Communications plan to include all stakeholders  Document and disseminate best practices

9. Developed sourcebook  5 key lessons 1. Share data 2. Listen to stakeholders 3. Change is hard 4. Let public health needs drive technology 5. Stay the course

10. Priority areas for integration  Vital registration  Newborn dried blood spot screening  Newborn hearing detection  Immunization  Other areas: WIC, lead screening, special needs registries, billing systems, birth defects surveillance, early interventions

11. Example: Utah  Child Health Advanced Records Management (CHARM)  Provides real-time access to data  Reduce duplicate data entry  Support coordinated service delivery

12. CHARM  Does not replace existing data systems  Serves as an electronic broker  Participating programs can link to CHARM; share data they choose to share  Participating programs retain stewardship of their data

13. CHARM  CHARM Core Council Program managers, UDOH senior management, technical staff and consultants Mechanism for developing a consensus on what is to be shared Provide input on potential uses of integrated data Primarily supported by federal grants

14. Where are we in New Jersey?  Vital Registration  Newborn screening  Newborn hearing  Immunization

15. Birth Registration  EBC – DOS-based 1995 Genesis Systems PCs using modems enter data from labor and delivery centers Transmit to local registrars - BVS

16. New Jersey Immunization Information System  Developed in 1997  http://njiis.doh.state.nj.us/njiis/index.htm http://njiis.doh.state.nj.us/njiis/index.htm  Contains over 500,000 records  2004 law requires participation, unless refusal  Located in Communicable Disease Service  Accessible by physicians and other providers

17. Early Hearing Detection and Intervention  Established in 2002 with CDC funding  Developed internally  Has been updated and improved  Monitors hospital compliance  Does not include out of state transfers

18. Newborn Biochemical Screening  NBS lab located in DHSS (PHEL)  Mandated to screen for 20 disorders  Actually screens for somewhat more  Notifies hospitals of results  Also notifies NBS Follow-up program  Follow-up program notifies pediatricians, parents, tracks outcomes

19. Newborn Biochemical Screening  Required by law, unless parents object  Began in 1964  Has expanded considerably since then  Results mailed from lab via USPS

20. Current level of integration  EHDI and NJIIS have signed MOA, so that hearing data is available to physicians accessing NJIIS  EHDI and NJIIS receive information from EBC – weekly files accessed via FTP  NBS not currently integrated with EBC

21. Vision for the future  Integration of all systems in a web- based “data mart”  Authorized users can obtain information in real time  EBC information is integrated with screening and immunization information  Pediatricians can access in real time

22. Progress toward goals  Have received HRSA funding to create integrated child health registry  Formed working group  Drafted RFP  In process of preparing for bids

23. Trauma Registry  Definition  Uses of a trauma registry Evaluate treatment; outcomes Proper triage/transfer procedures Injury surveillance, prevention activities

24. Trauma registry  Background Has legislation to establish state trauma registry; no rules  Current status Central Nervous System injury registry Transition to statewide trauma registry Trauma centers Other acute care hospitals

25. Pediatric critical care registry  Developed by Governor’s Emergency Medical Services for Children Advisory Council  Purpose: Develop a registry of critically ill or injured pediatric patients  Track outcomes; evaluate treatment  Develop best practices

26. Plans for Development  Web-based registry minimizing duplication  Will be implemented as part of New Jersey Trauma Registry  Hospitals should begin piloting by Fall 2008  Challenges

27. Electronic Death Registration System

28.  Benefits of EDRS  Background  Current status  Challenges

29. What is EDRS?  Electronic filing of death certificates  On-line collaboration among multiple death registration system users  User-friendly death record data entry screens Fact-of-Death data Cause-of-Death data  Built-in instructions and on-line/telephone helpdesk  Internet accessibility 24/7  Electronic authentication User IDs/passwords Adapted from Electronic Death Registration Systems in the United States Accessed 3/08 from www.naphsis.orgwww.naphsis.org

30. Who benefits from an EDRS?  Physicians and medical examiners  Institutions Hospitals Nursing Homes Hospice Long Term Care  Funeral directors  State and Local registrars  Federal, state and local agencies  Public health researchers  Families Adapted from Electronic Death Registration Systems in the United States Accessed 3/08 from www.naphsis.orgwww.naphsis.org

31. Benefits of NJ-EDRS  Sends timely email alerts when an electronic signature is needed to certify a death  Staff can quickly and easily enter decedent information for physician review and certification  Empowers facilities with reporting features

32. Alaska California Idaho Oregon Washington Montana Wyoming Utah Colorado Arizona New Mexico Texas Oklahoma Kansas Nebraska South Dakota North Dakota Minnesota Wisconsin Iowa Illinois Ohio Indiana Kentucky WV Virginia N. Carolina Georgia Florida Alabama MS Missouri Arkansas LA Nevada Hawaii Michigan Pennsylvania NJ New York CT MA VT NH Maine Tennessee MD DE RI DC S. Carolina United States Electronic Death Registration Systems, by Jurisdiction, With SSA Funding Indicator, July 2007 New York City Status DeployedIn DevelopmentPlanning/Requirements Stage Received SSA Funding * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

33. New Jersey Mandatory EDRS  Physician use of the EDRS is required by law: 26:8-24.1 New Jersey Electronic Death Registration System (NJ-EDRS); establishment “…All participants in the death registration process, including, but not limited to, the State registrar, local registrars, deputy registrars, alternate deputy registrars, subregistrars, the State medical examiner, county medical examiners, funeral directors, attending physicians and resident physicians, licensed health care facilities, and other public or private institutions providing medical care, treatment or confinement to persons, shall be required to utilize the NJ-EDRS to provide the information that is required of them by statute or regulation.” The State Registrar will send official notice identifying the date for mandatory compliance with this law, but all persons are encouraged to begin using the system now.

34. Phased Approach to EDRS Training Phase I  Pilot – Completed May 2007 Training of Registrars, Funeral Directors and 3 medical facilities in the pilot county (Mercer) Medical Examiners statewide were trained during the pilot  Phase I – June 2007 to Present, Concurrent training of: 566 Local Registrar Offices  Completion Oct 2007 800 + Funeral Homes  Target completion by early 2009  To date, Funeral Directors have been trained in Mercer, Hunterdon, Warren, Sussex, Middlesex, Monmouth, Ocean, Burlington, Somerset and Passaic counties

35. Phased Approach to EDRS Training Phase II-III  Phase II – Training of Medical Facilities Hospitals, Long Term Care, Nursing Homes, Hospice  943 Medical facilities to be trained  Medical Facilities, staff and affiliated physicians will receive training beginning Spring of 2008  Phase III – Training of Private Practice Physicians Training to commence upon the conclusion of Phase II Physicians can self-register and utilize on-line tutorials

36. Additional Training Tools  CD-ROM Tutorial  Medical Certifier Quick Reference Guide  EDRS powerpoint presentation  Posters, fliers, magnets  24-hour Help Desk  Reference Guides for: Medical Facility Administrators Long Term Care Hospice Nursing Homes

37. Simple Physician Self-Registration Go to EDRS Homepage - https://edrs.nj.govhttps://edrs.nj.gov

38. Complete Initial Registration Page

39.  The Medical Facility Administrator EDRS requires each facility to identify a person to serve as an administrator Set up and monitor EDRS for the facility Affiliate users and manage who is allowed to access the facility’s cases Serve as an on-site point person for EDRS training EDRS User Accounts for the Medical Facility

40. EDRS contact information 24 hour-a-day Help Desk By phone: 866-668-3788 By email: helpdesk@doh.state.nj.ushelpdesk@doh.state.nj.us

41. New Jersey Health Information Technology Commission  Established under P.L. 2007, c.330  “New Jersey Health Information Technology Act”  To work with Office of e-HIT (DOBI)  Responsible for approving state health information technology plan  Development of electronic medical records

43. New Jersey Health Information.,..  Background  Authorizing legislation  Current status

44. RHIOS  Current status

45. Private Sector initiatives

46. Federal government initiatives

47. Overview  What we can expect