1. Public Health Data Standards Consortium http://www.phdsc.org http://www.phdsc.org

2. Public Health Data Standards Consortium CDA EHDI Pilot Project Clinical Document Architecture (CDA) for Public Health CDA State EHDI Pilot Projects

3. Agenda Review Project Goal Update on pilot progress Review some of lessons learned Discuss Next Steps

4. Enable standardization of Early Hearing Detection and Intervention (EHDI)-related information exchanges for State EHDI Programs develop and test interoperability standards for HIT products used in EHDI information exchanges deploy standards-based HIT solutions in State EHDI Programs CDA EHDI Pilot Project: Pilot Goal

5. 2 participants  North Dakota  Oregon 12 Observers  Florida  Maryland  Massachusetts  Michigan  Missouri  Ohio  Pennsylvania  Rhode Island  South Carolina  Texas  Washington  Deloitte Consulting CDA EHDI Pilot Project: Recruitment

6. CDA EHDI Pilot Project: State-Specific Use Case 1.Child is delivered. 2.Clinician conducts initial physical exam 3.Newborn is due for hearing test 4.Clinician orders an hearing test 5.Hospital staff conducts hearing test 6.Hospital staff enter data on the hearing test in EHR-S & generate Newborn Hearing Screening (NHS) Outcome Report 7.Information is electronically sent on NHS Outcome Report to EHDI IS directly or via HIE 8.EHDI IS receives Notification of Report Availability 9.PH programs’ staff reviews the report and create PH EHDI IS record on a child in EHDI IS and upload NHS Outcome Report EHDI IS 10.PH IS sends Acknowledgement of Receipt of the Report (ACK) to EHR-S directly or via HIE. 11.EHDI IS generates Early Hearing Care Plan (EHCP) 12.EHCP is electronically sent to Pediatrician EHR-S directly or via HIE 13.EHR-S sends ACK to EHDI-IS directly or via HIE Use Case Actors: Flow of Events Data Categories 1&2. Demographics, Labor & Delivery Record, Newborn EHR 3. Consent 4. Standing Order 5. Hearing Test Results 6. Hearing Test Results, NHS Outcome Report 7. NHS Outcome Report 8. Notification of Report Availability 9. Updated Pubic Health EHDI Record 10. Acknowledgement of Receipt 11. EHCP 12. Notification of Report Availability Newborn Hearing Screening Newborn, Caregiver, Clinicians, Public Health Program Staff EHR, HIE, Public Health (PH) EHDI IS Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

7. CDA EHDI Pilot Project: Oregon Use Case 1.Child is delivered. 2.Clinician conducts initial physical exam 3.Newborn is due for hearing test 4.Clinician orders an hearing test 5.Hospital staff conducts hearing test 6.Hospital staff enter data on the hearing test in EHR-S & generate Newborn Hearing Screening (NHS) Outcome Report 7.Information is electronically sent on NHS Outcome Report to EHDI IS directly or via HIE 8.EHDI IS receives Notification of Report Availability 9.PH programs’ staff reviews the report and create PH EHDI IS record on a child in EHDI IS and upload NHS Outcome Report EHDI IS 10.PH IS sends Acknowledgement of Receipt of the Report (ACK) to EHR-S directly or via HIE. Use Case Actors: Flow of Events Data Categories 1&2. Demographics, Labor & Delivery Record, Newborn EHR 3. Consent 4. Standing Order 5. Hearing Test Results 6. Hearing Test Results, NHS Outcome Report 7. NHS Outcome Report 8. Notification of Report Availability 9. Updated Pubic Health EHDI Record 10. Acknowledgement of Receipt Newborn Hearing Screening Newborn, Caregiver, Clinicians, Public Health Program Staff EHR, HIE, Public Health (PH) EHDI IS Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System EHDI IS Daily updates

8. CDA EHDI Pilot Project: North Dakota Use Case 1.Child is delivered. 2.Clinician conducts initial physical exam 3.Newborn is due for hearing test 4.Clinician orders an hearing test 5.Hospital staff conducts hearing test 6.Hearing device data from the hearing test is collected & newborn admission notification information is generated 7.Information is electronically sent to EHDI IS directly or via HIE 8.EHDI IS receives Notification of Report Availability 9.EHDI-IS receives data and creates PH EHDI IS record on a child 10.EHDI IS generates Early Hearing Care Plan (EHCP) 11.EHCP is electronically sent to Pediatrician EHR-S directly or via HIE 12.EHR-S sends ACK to EHDI-IS directly or via HIE Use Case Actors: Flow of Events Data Categories 1&2. Demographics, Labor & Delivery Record, Newborn EHR 3. Consent 4. Standing Order 5. Hearing Test Results 6&7. Hearing Test Results, Newborn demographics 8. Notification of Report Availability 9. Updated Pubic Health EHDI Record 10. EHCP 11. Notification of Report Availability Newborn Hearing Screening Newborn, Caregiver, Clinicians, Public Health Program Staff EHR, HIE, Public Health (PH) EHDI IS Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System (EHDI IS) Daily updates

9. North Dakota - EHDI Pilot Design Standards-based information exchange using IHE Newborn Admission Notification Information (NANI), IHE Patient Care Device Technical Framework (PCD-01), IIHE Early Hearing Care Plan (EHCP), and IHE Cross-enterprise Document Reliable Interchange (XDR) Sanford Health (Epic) State Public Health Electronic Health Record System Care Provider North Dakota EHDI Information System (OZ) eSP Communication Server (OZ) Public Health Hearing Device Sanford Health Electronic Health Record System PCP/ Pediatrician Content Creator EHCP Document Content Consumer Admission Information Source Admission Notification Manager Newborn Admission Subscriber Device Observation Reporter Device Observation Consumer EHCP Document Content Consumer Newborn Admission Notification Information (NANI) Hearing Screening Result Message Early Hearing Care Plan (EHCP) ASCII File Trinity HealthEpic 2012 Test Harness

10. Public Health Communication Server (OZ) Oregon - EHDI Pilot Design Form Manager Form Receiver Content Creator Form Filler 1. Request Form 2. Pre-population data 3. Prepopulated NHS Form 4. Populated NHS Form 5. NHS report data CDA-based Actor Diagram using actors from IHE Retrieve Form for Data (RFD) and Cross-enterprise Document Reliable Interchange (XDR) Content Consumer OHSU Legacy Health (Epic 2012) State Public Health Electronic Health Record System Care Provider Oregon EHDI Information System (locally developed, based on Filemaker) EHDI Gateway (Orion Rhapsody) Newborn Hearing Screening CDA Document Continuity of Care Document (CCD) (pre-population data)

11. Derived NHS CDA model from IHE EHCP model in MDHT Developed data dictionary of data elements Mapped EHDI program reqs to CDA model Mapped EHR data elements to EHDI reqs Constrained per project timeline Results: Jurisdiction-specific Newborn Hearing Screening Outcome Report CDA EHDI Pilot Project: Data Requirements

12. Risk Indicators for Hearing Loss Active Problems Physical Exam Review of Systems Care Plan Procedures and Interventions Hearing Screening Coded Results CDA EHDI Pilot Project: EHCP Model

13. Addressed by Early Hearing Care Plan RecordTarget DocumentationOf/SerivceEvent InformationRecipient RecordTarget/guardian RecordTarget/patientRole/id RecordTarget/languageCommunication RecordTarget/patientRole/organization Newborn Hearing Screening Procedures Newborn Hearing Screening Results NHS CDA Document Perspective Header Body

14. Subset of Early Hearing Care Plan (EHCP) Header Hearing Screening Coded Results Procedure Information Test Results – Left Ear Procedure Information Test Results – Right Ear Procedure Information CDA Newborn Hearing Screening Outcome Report Data Model

15. CDA NHS Outcome Report XML CDA NHS Outcome Report Human Readable

16. CCD – HL7 Continuity of Care Document CDA – HL7 Clinical Document Architecture EHCP – IHE Early Hearing Care Plan HL7 – Health Level 7 IHE – Integrating the Healthcare Enterprise MDHT – Model Driven Health Tools NHS – Newborn Hearing Screening Outcome Report RFD – IHE Retrieve Form for Data Capture Glossary

17.  Recruitment: Aug – Sept ✔  Pilot Design: November – March 2012 ✔  North Dakota – December  Oregon – March  Implementation: January - May 2012 ✔  North Dakota – January  Oregon – May  Testing: February – May 2012   Connectathon – Feb, 2013  HIMSS - March, 2013  Field test (system patient data) – March - May, 2013  Final Report: April - June 2013  CDA EHDI Pilot Project: Timeframe for ND

18. Set clear expectations and requirements Involve stakeholders in early planning process Delineate project outcomes  PH program  System Vendors  Participating Partner Organizations, eg. Birthing Facility Obtain partner commitment earlier in project Verify project timeline constraints and conflicts Provide additional standards implementation resources and sample implementations CDA EHDI Pilot: Lessons Learned

19. Complete remaining testing activities Collect remaining reports, report information Complete draft pilot report and send for review Complete final report Update project resources with detailed pilot information Start planning activities for next pilot CDA EHDI Pilot: Next Steps

20. Questions? CDA EHDI Pilot Project