1. WHY is EHDI a part of the HIT conversation A first encounter between providers and public health As an encounter, communication becomes essential Communication is about interoperability between/among systems Interoperability has been elusive

2. IHE EHDI Content Profile  Describe HIT interoperability standards and data requirements for Short-Term Follow-up and Clinical Surveillance.  Interoperability: the ability to exchange information and maintain its meaning  Short-Term Follow-up includes audiologic diagnosis and early intervention until age 3 years.  Clinical surveillance by primary care promotes recognizing children at risk for delayed onset or progressive loss.

3. Alphabet soup or something Else?

4. Abbreviations you’ll see today Domain Abbreviations  EHDI Early Hearing Detection and Intervention  NHS Newborn Hearing Screening  TOAE Transient Otoacoustic Emission  EHCP Early Hearing Care Plan Actors Health Information Technology (HIT) – Technical Actors  EHR Electronic Health Record  PHR Personal Health Record  HIE Health Information Exchange  HS Devices Hearing Screening  EHDI –IS Information System

5. What are the EHDI Content Profile Goals?  Assist early hearing detection efforts by providing an EHCP  EHCP will go to authorized providers as guided by Public Health EHDI  EHCP facilitates documentation and reporting  Establish quality measures for birthing facilities and providers –  Provide public health with the tools for health surveillance to ensure a child’s access to care and resources

6. EHDI USE CASES  UC1: NHS in Birthing Facility  UC2: Normal NHS Results; No Known Risk Factors  UC3: NHS: Not Complete / Referred for Screening  UC4: Audiologic Diagnosis; Referral to Early Intervention  UC5: Clinical Surveillance Monitoring for Delayed, Progressive or Incident-based Hearing Loss

7. What “structured actor activities” will the use cases support?  Communicate NHS guidelines from EHDI-IS to other EHR-S  Report demographics on ALL births from Birthing Facility’s EHR-S to Public Health EHDI-IS  Report HS Results from HS device to Public Health EHDI-IS (Alternative flow: to Birthing Facility EHR-S or outpatient screening facility EHR-S) and then to EHDI-IS)  Report Early Hearing Care Plan (EHCP) from EHDI-IS to EHR-S (Birthing Facility, PCP, Audiologist).

8. What “structured actor activities” will the use cases support?  Report Diagnostic evaluations by providers (audiologists) to EHDI-IS and PCP EHR-S  Communicate HS Results, EHCP instructions and educational materials from EHDI-IS to child’s PHR-S; and from EHR-Ss (Birthing Facility, PCP, Audiologist) to child’s PHR-S  Communicate jurisdiction-specific Surveillance Reports and Quality Assessment Reports from Public Health EHDI-IS to EHR-Ss (Birthing Facility, PCP, Audiologist)

9. Use Case Roles Actor: Knowledge Requestor Role: formulates and sends a request for medical knowledge Actor: Knowledge Resource Role: holds the information requested and responds to requests from the Knowledge Requestor Perspectives

10. UC1: The birthing facility  Integrating the Healthcare Enterprise (IHE). Quality, Research and Public Health Committee (QRPH). Newborn Screening (NBS) White Paper. 2009 URL: ftp://ftp.ihe.net/Quality/2009_2010_YR_3/Planning/ White papers yr 3/Newborn Screening/IHE_QRPH_Newborn_Screening_WhitePaper_Fi nall_2009-08-26.docftp://ftp.ihe.net/Quality/2009_2010_YR_3/Planning/ White papers yr 3/Newborn Screening/IHE_QRPH_Newborn_Screening_WhitePaper_Fi nall_2009-08-26.doc Health Information Technology Standards Panel (HITSP). Newborn Screening Interoperability Specification (IS) 92. URL: http://www.hitsp.org/InteroperabilitySet_Details.aspx?Mast erIS=true&InteroperabilityId=694&PrefixAlpha=1&APrefix=I S&PrefixNumeric=92 http://www.hitsp.org/InteroperabilitySet_Details.aspx?Mast erIS=true&InteroperabilityId=694&PrefixAlpha=1&APrefix=I S&PrefixNumeric=92

11. UC2 Normal NHS, No risk factors At well-child visit, PCP reviews EHCP. Screening is “pass right; pass left”. EHCP has an outcome of normal HS. EHCP provides next steps. Dr conducts risk factor assessment with parent, ascertains no family history or other risk factors for delayed, progressive hearing loss and discusses developmental milestones for speech and language. Provides parent EHCP for PHR-S. Visit information is sent to EHDI-IS PCP will ask about hearing as part of early and continuous screening at well-child visits.

12. UC3: NHS Not Complete / Referred for Rescreen  At well-child visit, PCP (or as jurisdictionally required) addresses need for additional screening with parent whose baby’s screen is not complete or whose screen is a refer  Screening is to be scheduled and completed by outpatient screening facility no later than one month of age

13. Use Case 4: Audiologic Diagnosis, Refer to Early Intervention EHCP has “HS bilateral referral; audiology diagnostic evaluation needed” and lists next steps Birthing Facility (or PCP) refers family to audiologist with expertise in infant evaluation. With parental permission, staff adds Audiologist as authorized to receive information from EHDI-S and schedules appointment for two weeks At visit, PCP reviews EHCP notes scheduled appointment and discusses importance of audiology evaluation. PCP conducts risk factor assessment that indicates that baby does not have known risk factors for delayed onset or progressive hearing loss. Staff provides parent with EHCP (Use Case 2), so it can be uploaded into PHR

14. Use Case 4: Audiologic Diagnosis, Refer to Early Intervention The audiologist diagnoses baby as “having a severe bilateral sensorineural hearing loss”. Audiologist counsels parent about options and care available and the need for continued evaluation. Audiologist refers family to EI Services (Part C Services ). Referral to EI is recorded in the EHDI-IS (or Audiologist EHR-S and sent to EHDI-IS to update EHCP) and to PCP EHR-S or published in HIE. Referral information is also provided to parents to be uploaded into PHR-S. Audiologist schedules a next appointment to explore additional testing and habilitation services

15. Use Case 3 Public Health EHDI Perspective: Flow of Events Data categories by events 3.3.1 As jurisdictionally defined (e.g., at 72 hours after birth), EHDI-IS automatically marks that newborn did not have NHS and assigns Outpatient Screening status as Required. 1. Notification of Birth 2. Filter for Incomplete/Missed NHS 3. Outpatient Screening Status 3.3.2 EHDI-IS retrieves NDS for the newborn to verify the reason for incomplete/missing NHS. 1. NDS with why test was not performed (Parental refusal, Attempted, Medical exclusion, Procedure failed, etc.) 2. Retrieve summaries from HIE (XPHR, XDS-MS) 3.3.3 EHDI-IS generates newborn’s EHCP that indicates and flags that child will “Receive Outpatient Screening” by 30 days of age. 1. EHCP 2. Flag for “Receive Outpatient Screening” 3.3.4 EHDI-IS publishes EHCP to HIE. Alternative Flow: EHDI-IS sends EHCP to PCP EHR-S. 1. EHCP 3.3.5 EHDI-IS generates Notification that EHCP was published in HIE; or sent to PCP EHR-S; or available for PHR-S 1. Notification of EHCP availability 3.3.6 EHDI-IS receives Notification that Referral for “Receive Outpatient Screening” by 30 days of age is published in HIE by EHR-S Alternative flow: PCP EHR-S sends Referral to EHDI-IS 1. Notification of Referral 2. Referral 3.3.7 EHDI-IS retrieves Referral for a newborn.1. Referral

16. Use Case 3 Public Health EHDI Perspective: Flow of Events Data categories by events 3.3.8 EHDI staff conducts follow-up via PHR-S or phone to assure that parents complete the referral. 1. Human readable instructions, education 3.3.9 EHDI-IS receives Notification that HS Results for “Receive Outpatient Screening” by 30 days of age were published in HIE Alternative flow: Outpatient screening clinic’s EHR-S sends HS Results to EHDI-IS 1. Notification of HS results 2. HS Results or reasons for incomplete/missed referrals, e.g., no- show. 3.3.10 EHDI-IS downloads HS Results and generates EHCP for a child. 1. HS Results 2. EHCP 3.3.11 EHDI-IS publishes EHCP with HS Results into HIE. Alternative flow: EHDI-IS sends EHCP with HS Results to outpatient screening clinic’s EHR-S and PCP EHR-S. 1. HS Results 2. EHCP 3.3.12 EHDI staff reviews EHDI-IS data on a jurisdictionally defined periodic basis and EHDI-IS generates HS Surveillance Report of “Receive Outpatient Screening by 30 days of age”, Referrals, Visits, and Reason for incomplete/missed referrals. 1. Aggregate summary: HS Surveillance Report – for a period of time  Referrals  Visits  Reasons for incomplete/misse d referrals e.g., no-show. 3.3.13 EHDI staff reviews EHDI-IS data on a jurisdictionally defined periodic basis and EHDI-IS generates Quality Assessment Report (referrals, visits, reason for incomplete/missed referrals) by outpatient screening clinic for quality assurance EHDI staff conducts follow-up on incomplete/missed referrals. 1. Quality Assessment Report 2. Quality Measures  EHDI 1c  EHDI 2a 3.3.14 EHDI-IS publishes into HIE Quality Assessment Report2. Quality Assessment Report