Transcript New Jersey Learning Session # 3

Utilizing a Statewide Immunization
Registry for EHDI Tracking and
Reporting
2007 National EHDI Meeting
Salt Lake City, Utah
March 26, 2007
presented by:
Kathryn Perko Aveni, RNC, MPH
Research Scientist, EHDI Program
co-author:
Zina Kleyman
NJIIS Project Manager
New Jersey Department of Health and Senior Services
Faculty Disclosure Information
In the past 12 months, I have not had a
significant financial interest or other
relationship with the manufacturer(s) of the
product(s) or provider(s) of the service(s) that
will be discussed in my presentation.
This presentation will not include discussion of
pharmaceuticals or devices that have not
been approved by the FDA.
New Jersey Immunization
Information System (NJIIS)
• Developed in 1997, web enabled since May 2002
• September 2, 2004 – Governor signed Immunization
Registry Act
• NJIIS was twice recognized by Centers for Disease
Control and Prevention
– October 27, 2003 - Connect Award
– October 18, 2004 - Grow Award
• October 2006 – named Best Practice of the Month by
American Immunization Registry Association
NJIIS Primary Purposes
• Provide current recommended immunization
schedule for all age groups
• Consolidate immunization information from all
providers into one record to provide an
accurate immunization assessment
• Eliminate the use of manual vaccine
administration logs
NJIIS Primary Purposes
• Ensure access to preventive health/screening
information such as immunization, Flu, TB,
Lead and Newborn Hearing Screening
• Help communities assess their immunization
coverage and identify pockets of need
NJIIS Technical Environment
• Technology Components
–
–
–
–
J2EE for middleware on Weblogic server v8.1
Oracle 9i for database
JSP/HTML for presentation
XML for data interfaces with external systems
• Infrastructure Components
– Intel-Xeon platform
– Windows 2003 servers
NJIIS User Environment
NJ State
BATCH PROCESSES
EMR, Billing
Electronic Birth Certificates
demographic and immunization
records from Medicaid and
WIC. Lead and Newborn
Hearing screening
INTERNET
Immunization Records
Schools, Daycares etc
Physicians
NJIIS
MCO, HMO
Clinics, Long-term
healthcare facilities
Local Health Departments
Hospitals
Data Entry and
Reports
Saturation Measures and
Immunization Coverage
Reports
NJIIS Statistics
• 450
Providers
• 1,100,000
Patients
• 10,000,000
Doses
Every month
• 7,000
Patients are loaded from EBC
• 4,500
Patients are entered through on-line
interactive data entry via Web
• 100,000 Doses are entered through on-line
interactive data entry via Web
• 25,000
Doses are loaded electronically from
Medicaid, EMR and billing systems
NJ EHDI – History
• 1977: Law required “evaluation” of newborns
for hearing loss
• 1980: Hospitals sent paper forms to DHSS for
babies with risk indicators for hearing loss
• 1994-1997: Risk indicators & screening
results (if done) now reported via EBC
• 2002: Law required universal newborn
screening. Inpatient results & risks reported
via EBC, outpatient results on paper form
NJ EHDI - Registry
Law includes:
– “The commissioner shall establish a central registry of
newborns…. for the purposes of compiling statistical
information and providing follow-up counseling, intervention
and educational services…”
– “A…professional who performs testing …shall report the
results…in a manner and on forms prescribed by the
commissioner.”
2002: EHDI database developed using Microsoft
Access. EBC records populate database. Paper
forms with outpatient test results data entered by
DHSS Clerk.
NJ EHDI - Statistics
2005 occurrent births (110,836 births):
• Screened either before d/c or by 1 mo: 99.0%
• Refer on final inpatient screening: 3.8%*
• Oupatient f/u on refers (rescreen or dx testing): 58.9%*
– Timely f/u (by 3 months): 44.1%
• Diagnosed w/ HL: 1.04 per 1000 births
• In EI by 6 mo: 37.7% of babies dx w/ HL
*Over 7500 paper outpatient follow-up reports submitted for
2005 births
NJIIS & EHDI Partnership
Why:
• Allow electronic Web-based reporting by providers
doing rescreening and diagnostic testing
– More timely
– Avoid duplicate and cumbersome writing of demographic
information
– Avoid errors & incomplete reports
– Ability to view previous results
• IIS system already in place – cheaper and easier
than building an EHDI Web system
• Pediatricians can check status of immunizations and
hearing in one system
NJIIS & EHDI Partnership
How:
• NJIIS in Division of Epidemiology, Environmental and
Occupational Health
• EHDI in Division of Family Health Services
• Preliminary meetings to discuss goals
• Memorandum of Agreement (MOA) signed by
assistant or deputy commissioner over each Division
• Transfer of funds from CDC & HRSA grants
Project Timeline
• Spring 2006: MOA developed, EHDI forms &
other specifications provided to NJIIS
• Spring-Summer 2006: NJIIS Programming
• Aug. 2006: Beta testing by EHDI program
• Sept. 2006:
– Inpatient screening results viewable to PCPs
– 4 facilities volunteered as pilot test sites for
entering outpatient results
• Dec. 2006: Began full roll-out/user training
System Overview
Home Page
http://njiis.nj.gov
Administrative login
Provider Setup
EHDI data
coordinator
has admin
access to
IIS system
to add
“EHDI
Providers”
Address info used to auto fill facility address on reports
User Setup
EHDI data coordinator also adds “EHDI Users”
System access can be revoked by simply checking box
User/Provider Setup
EHDI Users can be assigned to multiple facilities:
practice with several offices, user w/ 2 part-time jobs
EHDI User login
User Login
Provider Choice
User starts
by
selecting
the facility
they are
reporting
from (if
work at >1
facility)
Search - Identifiers
User can choose to search with child info, identifiers or
mother’s name
Search – Child Name/DOB
Search Results can be
re-sorted by any column.
In this example the
results are re-sorted by
Birth date.
To re-sort the list
click on column title
Patient Information Page
EHDI Users have access to only certain tabs (aliases, &
addresses, but not immunization and med hx)
Aliases
AKAs can be entered and are used in generating search
screen results
Relatives/Addresses
Alternate guardians can be added.
Address/phone number info can be updated
Patient Information Page
Hearing Screening link is only
active for “EHDI Users” and
Pediatricians who have
“claimed” PCP status for child
Audiology Facility of Record
EHDI Users are asked to note if they are “primary”
audiology follow-up facility for purposes of reports
EHDI Summary Page
Initially
displays
risk info
and
inpatient
screening
results
from EBC
Clicking an
exam date on
the summary
page opens
full report
EBC system
includes some
HL risk
indicators
EHDI Summary Page
Buttons at the bottom of the
screen are clicked to start a new
outpatient follow-up report
Summary
of
outpatient
follow-up
is added
as forms
are
completed
in the
system
Demographic
section is
auto-filled
with
information
already
stored in the
NJIIS
system
Reason for
testing also
auto-fills
Facility
name &
address is
auto-filled
based on
user login
Risk Indicators Pop-up Box
Test result
sections are
mainly
check
boxes.
Evaluator is
pick list of
people
working at
that facility.
Phone autofills based
on phone
number
stored in
user setup
Saving form
triggers data
validation
checks:
•Must have
exam date
•Exam date
must be >
DOB
•If dx HL
must have
type &
degree
•Etc.
Form can be printed after saving (to send copy
to pediatrician)
DHSS does not require a paper copy
EHDI Summary Screen – Pedi User
Pediatricians
have ability to
view results
and can
generate a
“lost” form. If
doing testing
in their office,
they must be
set up with
“EHDI User”
user names
Demographics
auto-fill the
same as with
the follow-up
report
Both Pediatricians and Audiologists have the ability to run
reports for “their” patients
Report Sample
EHDI program in administrative section can create
extract to export data to Excel
User Training
User Training
• Several hospitals were asked to volunteer
computer rooms. 4 hospital sites were used.
• Medical Coordination Centers (MCC)
– DHSS maintains 8 facilities throughout the
state as response coordination centers for
mass casualty incidents (bioterrorism,
natural disaster, epidemic outbreak). 5 of
these sites were used.
User Training
New Jersey
• 4th smallest state in US
• 70 miles wide/150 miles long
MCC Training Sites
Hospital Training Sites
User Training
• Notification via email to hospital-based EHDI
contacts and providers who previously
submitted forms
• Follow-up phone calls to large volume
facilities that did not register promptly
• Attendees received certificate for 3 continuing
education hours that can be used for State
audiology licensure requirements
User Training
• A training version of system was used to allow “fake”
data entry on “fake” children
• Case studies were developed representing a variety
of scenarios (rescreening, diagnosed hearing loss,
lost to follow-up, out-of-State birth, etc.)
– 7 scenarios X 15 users
• 2 or 3 EHDI-team members were at each location to
allow for room roaming/troubleshooting
User Training
December 13, 2006 – February 28, 2007
• 12 sessions held at 9 sites (am & pm at some sites)
• Between 6 and14 users were signed up for each session
• Staff from 42 hospitals/audiology facilities trained
• 117 users trained
– audiologists, techs, secretaries, maternity dept. staff
• Some additional users will be trained by co-workers who
attended training sessions
• A couple additional sessions will be offered in May, then
probably annually
The EHDI program is grateful for a very mild NJ winter 
Hospital Computer Room
Hospital Computer Room
Hospital Computer Room
MCC
MCC
Phase in of IIS Use
# forms data
entered:
IIS – DHSS vs. Self-Report
# forms data
entered:
800
700
600
500
IIS - Aud
IIS - DHSS
400
300
200
100
0
Sept
Oct
Nov
Dec
Jan
Feb
Challenges, Barriers
and Works in Progress
Historical EHDI Data
• Inpatient results only loaded for births after 1/1/06
– Plan to add births back to 2003 during 2007
• Outpatient follow-up only in system since Fall 2006:
– For pilot test sites since Oct. 2006
– All paper forms received after Nov. 1 2006 entered
into IIS
– During 2007, plan to back load forms entered in
prior Access EHDI database. BUT form design
was updated in early 2006 – so older forms can’t
be ‘mapped’ to fields on current forms.
Added Patients/Duplicates
• If search for child is unsuccessful on the
search screen, EHDI user can add patient to
the system
• IIS system starts a record for babies from:
– EBC records from Vital Statistics
– Pediatrician offices can add patients
– EHDI users can add patients
Added Patients/Duplicates
EBC system will initiate an NJIIS record only when:
• Parent consented to IIS participation. If IIS consent
field in EBC is “no”, no IIS record is created
– For 2006 births 74% yes, 5% unknown, 21% no
• File has been uploaded from the hospital’s EBC (via
modem – using old DOS system) to Vital Statistics
– should occur w/in 5 days of discharge – currently about 55%
were submitted in 5 days, 84% by 2 weeks
• NJIIS must receive file from VS (once/week)
Added Patients/Duplicates
• “Adds” by EHDI users are common due to:
– Time lag
• Rescreen at 1 wk of age, often not in IIS yet
– Unsuccessful search efforts by users
• Often know as “baby boy/girl [mom last name]”
and not legal (EBC) name
• “Two last name” babies often don’t hit on
Soundex match
• Late EBC records will merge automatically with
“adds” if mom/baby name and DOB match. If no
match, may result in duplicates – need manual
cleaning
Transfers
• IIS Program did not receive any records on
transferred babies prior to 1/1/07
• Therefore IIS populated with birth hospital
results only (typically none)
• Transfer records now being sent to IIS
program, but must have enough data to
match
Summary – Using IIS for EHDI
Reporting
• Addition to currently used system allowed a very
cost-effective way to incorporate electronic reporting
• Brings Pediatricians into process
• End-user friendly
– exactly mimics paper report forms
– pilot tested by high volume or unique situation locations
• Large, free, and hi-tech training rooms were
important to successful roll-out
• Ongoing “tweaking” of system and process is
anticipated