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NAPHSIS Annual Meeting 2015 Slide 1NAPHSIS ANNUAL MEETING | PITTSBURGH | MAY 31-JUNE 3, 2015
VITAL STATISTICS: BUILDING BRIDGES TOGETHER
Where do babies’ (data) come from?
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NAPHSIS Annual Meeting 2015 Slide 2
Birth Data:Where does it come from?
Daryl Wieland, MD
Vice ChairDepartment of ObGynJacobi Medical Center
Bronx, New York
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NAPHSIS Annual Meeting 2015 Slide 3
Financial Disclosures
• I have no financial disclosures
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NAPHSIS Annual Meeting 2015 Slide 4
PITTSBURGH
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NAPHSIS Annual Meeting 2015 Slide 5
Learning Objectives
• Describe the timing of data entry into thehealth record during prenatal care
• Understand the role of the EHR in healthcare
• Determine who else wants the same data andfor what purposes
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NAPHSIS Annual Meeting 2015 Slide 6
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NAPHSIS Annual Meeting 2015 Slide 7
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NAPHSIS Annual Meeting 2015 Slide 8
Building Materials
Standard Work• Build a Common Clinical Data Set
• Share information
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NAPHSIS Annual Meeting 2015 Slide 9
Data Quality
• Provenance
– Source
– Timing
• Characteristics
– Qualitative vs Quantitative
– Data element vs Free text
• How the question is worded
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NAPHSIS Annual Meeting 2015 Slide 10
Information from First prenatal visitSource: Office Visit, Ob Provider
• LMP
• Infertility Treatment
• Previous live births &other outcomes
• Height, Weight of mother
• Cigarette Smoking
• Risk Factors
– Past medical history
– Previous preterm birth
– Previous Cesarean Section
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NAPHSIS Annual Meeting 2015 Slide 11
Prenatal VisitsSource: Office Visit, Ob Provider
• Determine the due date
• Infections – Lab results
• Procedures performed– Ultrasound, Genetics
testing, cerclage,
• Risk Factors– Diabetes
– Hypertension
• Date of last visit and #of prenatal visits
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NAPHSIS Annual Meeting 2015 Slide 12
Delivery DataSource: Birth Facility, Maternal Record
• Onset of Labor
• Characteristics of Labor& Delivery
• Method of Delivery
• Anesthesia
• Other Procedures
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NAPHSIS Annual Meeting 2015 Slide 13
Newborn DataSource: Birth Facility, Newborn Record
• Weight
• Apgars
• Plurality and birth order
• Abnormal Conditions
• Congenital Anomalies
• Immunizations
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NAPHSIS Annual Meeting 2015 Slide 14
Post PartumSource: Birth Facility, Maternal Record
• Maternal Morbidity
• Breastfeeding
• Discharge or Transfer
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NAPHSIS Annual Meeting 2015 Slide 15
Birth Data
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NAPHSIS Annual Meeting 2015 Slide 16
Problems with current system
• Multiple Sources of Original data
– Prenatal record never makes it to delivery site
• Manual data entry and duplicative processes
• Timeline of data spans 10 months
• Everyone is doing the same thing in manydifferent ways
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NAPHSIS Annual Meeting 2015 Slide 17
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NAPHSIS Annual Meeting 2015 Slide 18
The EHR
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” President George W. Bush State of the Union Address January 20, 2004
• He set a timeline of 10 years • Added $100 million to budget• Created a subcabinet position in HHS
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NAPHSIS Annual Meeting 2015 Slide 19
American Recovery and Reinvestment Act of 2009 (ARRA)
HITECH Act
Financial Incentives for Providers
Certification of EHR Technology
Requires the meaningful use of certified technology
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NAPHSIS Annual Meeting 2015 Slide 20
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NAPHSIS Annual Meeting 2015 Slide 21
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NAPHSIS Annual Meeting 2015 Slide 22
State comparison of adoption compared to prior years. HealthIT.gov April 2015
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NAPHSIS Annual Meeting 2015 Slide 23
Construction on the Tappan Zee
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NAPHSIS Annual Meeting 2015 Slide 24
Who wants the data?
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NAPHSIS Annual Meeting 2015 Slide 25
EVERYONE WANTS YOUR DATA!
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NAPHSIS Annual Meeting 2015 Slide 26
Birthing Facility
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NAPHSIS Annual Meeting 2015 Slide 27
Continuity of Care
• OB providers – outpatient and inpatient
• Consultants
• Pediatricians
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NAPHSIS Annual Meeting 2015 Slide 28
Performance Measures
• Establish Gestational Age• Prenatal Care Screening• Behavioral Health Risk Assessment• BMI Assessment• Elective Deliveries <39 wks• Cesarean Deliveries for low risk nullip• Episiotomy• Spontaneous Labor & Birth• Care Coordination• Postpartum Care Follow up
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NAPHSIS Annual Meeting 2015 Slide 29
Personal Health Records
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NAPHSIS Annual Meeting 2015 Slide 30
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NAPHSIS Annual Meeting 2015 Slide 31
Constraints and Barriers
• Resources
• Data Capture within EHR
– Common Clinical Dataset
– Quality and completeness
• Data Sharing
– Messaging Standards and Technical Frameworks
– Privacy Concerns
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NAPHSIS Annual Meeting 2015 Slide 32
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NAPHSIS Annual Meeting 2015 Slide 33
Can this be done?
• Minnesota Test Case
• Utah Test case
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NAPHSIS Annual Meeting 2015 Slide 34
Minnesota eBirth Records Project: Assessing Readiness for e-Birth Records Standards. Minnesota Department of Health, April 2014
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NAPHSIS Annual Meeting 2015 Slide 35
Minnesota eBirth Records Project: Assessing Readiness for e-Birth Records Standards. Minnesota Department of Health, April 2014
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NAPHSIS Annual Meeting 2015 Slide 36
Overcoming Barriers
• Policies
• Pooling our resources – working with provider organizations
– AMA, ACOG, SMFM,ACNM, AWHONN, AAP, AAFP
• Technical Guidance to vendors on both sides of the equation
– EHR vendors & Vital Statistics vendors
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NAPHSIS Annual Meeting 2015 Slide 37
PITTSBURGH
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NAPHSIS Annual Meeting 2015 Slide 38NAPHSIS ANNUAL MEETING | PITTSBURGH | MAY 31-JUNE 3, 2015
VITAL STATISTICS: BUILDING BRIDGES TOGETHER
Thank YouDaryl Wieland, MD
Jacobi Medical Center
Bronx, NY