baby’s first message: next steps and lessons learned after … · 2017-09-13 · • electronic...

Baby’s First Message: Next Steps and Lessons Learned after Achieving Statewide Implementation of an Electronic System

Amy Gaviglio| Genetic Counselor/Follow-Up Supervisor

September 12, 2017

A look back:

September 2014 to June 2017

Presenter

Presentation Notes

Purpose of slide is to describe impact – data pulled from 2015 EHDI Annual Report

Electronic Reporting

Hearing screening results uploaded or streamed from screening device (via OZ Telepathy EHDI/CCHDTM)

Newborn Screening and birth hospital staff view reported information in MNScreen web portal

EHR

MNSCREEN

Demographics and contact information sent through HL7 ADT (via OZ NANITM)

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Contract signed with vendor

Contacted hospitals and hosted first informational calls

Declared Meaningful Use

Today: 90/90 birth hospitals live!

MNScreen Implementation Timeline

Paper Reporting

5

Staff update demographics in

EHR

Staff admit patient to EHR

Staff use EHR to write

demographics on blood spot card

Staff type demographics into screening device

Staff screen patientStaff type

screening results into EHR

Staff write screening results

on blood spot card

Staff mail blood spot card to

Newborn Screening program

Staff type demographic

information into database

Staff type screening results

into database

Staff follow-up on patient if needed

Staff rescreen patient if needed

Birth Hospital

Newborn Screening

Presenter

Presentation Notes

Green is where errors can occur in process Paper reporting resulted in numerous challenges including: Inaccurate or missing results Inaccurate or missing demographic information Staff time dedicated to locating missing information Follow-up on refers that actually passed and vice versa


6

Staff update demographics in

EHR

Staff admit patient to EHR

Staff type demographics into screening device

Staff screen patient

Staff upload screening results

from device to network folder

MNScreen receives HL7 ADT message (via OZ NANITM) and record is

created

OZ Telepathy EHDITM

matches screening results to record

Staff follow-up on patient if needed

Staff rescreen patient if needed

Birth Hospital

Newborn Screening


Successes

• All birth hospitals onboarded as of June 2017

• MNScreen declared as a specialized registry for Meaningful Use

• Timely and accurate reporting

• Integration of clinical decision support

7

Challenges

• Stakeholder engagement

• Obtaining certain data elements and device connectivity issues

• Critical access hospitals and out-of-hospital birth population

• Staff time, end user training, ongoing training, and maintenance

Lessons Learned

8

• Always be ready for the unexpected…

• Utilize project management tools and techniques and keep a problem log

• Each facility is different.

• Electronic Reporting Removes Some Issues, and Creates Others:

• Post-production monitoring necessary when project involves workflow changes

• Still see:

• Serial screening

• Algorithm adherence

• Mis-entry into EMR

Looking forward:

2017 and beyond

What’s next?

• Electronic reporting of outpatient hearing screening results and diagnostic assessments

• Send hearing & CCHD screening results to hospitals’ EHRs for auto charting

• Send demographic information to laboratory information system for newborn blood spot screening

• Electronic Lab Ordering and Reporting via HL7 through Exchange Hub

NewSteps 360 Grant

Need versus Nice to Have

• Currently have 37 fields on Newborn Screening Card

• Program analyzed data quality and use of each field and decided to remove in order to simplify the order message:

• Birth Defects: Y/N

• Deceased Siblings: Y/N and Cause of Death:

• Maternal Pregnancy Complications (AFLP/HELLP): Y/N

• Family Hx of Disorder on Screening Panel: Y/N

• Antibiotics: Y/N

• Collected By

• Breast vs. Milk vs. Soy formula (retained TPN (Y/N) only)

9/13/2017 Optional Tagline Goes Here | mn.gov/websiteurl 11

Utilizing the Existing Connection

EHR MNSCREENHL7 ADT (via OZ NANITM)

NATUS

MDH INTERNAL EXCHANGE HUB

This process will capture 22/30 fields on card

What about the remaining 8 fields?

EHR HL7 ORM

NATUS

MDH INTERNAL EXCHANGE HUB

Matched to demographics from OZ NANITM ADT in holding table

• DOC• TOC• TPN (Y/N)• Transfused (Y/N)• Transfusion Date• PCP/Clinic • Barcode

1) Currently constraining HL7 Version 2.5.1 Implementation Guide: Laboratory Orders (LOI) from EHR

2) AOEs will be used to obtain fields not readily accessible in EHR:• TPN (Y/N)• Transfusion (Y/N)• Primary Physician/Clinic

Presenter

Presentation Notes

The order questions are mapped in the Resulting Agency record, not in Identity. The procedures, result components and department are mapped in Identity. Map each Epic procedure to the reference lab order ID. You can only have one reference lab ID per Epic EAP (procedure record). Map each result component to the corresponding reference lab component ID(s). You can have more than one reference lab ID per LRR (component record).

Amy [email protected]

651-201-5451

Thank you: Kaitlin Houlihan, Jill Simonetti, Heather Brand,

Sarah Shaw, OZ Systems, Natus, MN Birth Hospitals,

Rebecca Johnson

baby’s first message: next steps and lessons learned after … · 2017-09-13 · • electronic...

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