John Eichwald, Team Lead

Early Hearing Detection and Intervention (EHDI)

National Center on Birth Defects and Developmental Disabilities

Centers for Disease Control and Prevention (CDC)

Public Health Data Standards Consortium

2012 Annual Business Meeting

November 9, 2012

Hyattsville MD

EHDI CDA Pilot Project

Newborn Hearing Screening

• U.S. Preventive Services Task Force (USPSTF)

recommends screening for hearing loss in all

newborn infants (Grade B - July 2008)

• Hearing loss is one of the core newborn

conditions on the Recommended Uniform

Screening Panel (RUSP) of the Secretary’s

Advisory Committee on Heritable Disorders in

Newborns and Children (SACHDNC)

Conditions Screened in the Newborn

About 12,500 infants are diagnosed with the core conditions each year with the current RUSP• Estimated annual numbers (the most common)

– Hearing Loss: 5,064

– Primary Congenital Hypothyroidism: 2,156

– Sickle Cell Disease: 1,775

– Cystic Fibrosis: 1,248

– MCADD : 239

CDC Grand Rounds - Newborn Screening and Improved OutcomesMorbidity and Mortality Weekly Report (MMWR) June 1, 2012

“1 – 3 – 6” EHDI Foundation

Healthy People 2020Hearing and Other Sensory or Communication Disorders

1

Screen no later than 1 month

3

Diagnose no later than 3 months

6

Intervene no later than 6 months

Two types of screening technologies• Otoacoustic Emissions (OAE)• Auditory Brainstem Response (ABR)

Screening

Photographs courtesy of the National Center for Hearing Assessment and Management (NCHAM)

EHDI Clinical Quality MeasureCMS Electronic Health Record (EHR) Incentive Program: Stage 2Final Rule published August 23, 2012

HL7 Messaging Screening Results OBR|17|128993^ST ELSEWHERE HOSPITAL^9999999999^NPI|999555^TNSPHLAB^77D7777777^CLIA |54111-0 ^Newborn hearing loss panel^LN|||201010141853|||^VH||||201010151121||1111111111^Smiles^Minnie^^^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^^^^^^^^MD||||||201010160918|||FOBX|1|TX|57700-7^Hearing loss newborn screening comment/discussion^LN||Any baby with clinical features suggestive of hearing loss requires clinical and diagnostic follow-up regardless of whether the NMS result is normal or abnormal.|||N|||FOBX|2|CE|54109-4^Newborn hearing screen – right ^LN||LA103921^Pass^LN|||N|||FOBX|3|CE|54108-6^Newborn hearing screen – left ^LN||LA103921^Pass^LN|||N|||FOBX|4|CE|54106-0^Newborn hearing screen method^LN||LA10388-9^Auditory brain stem response^LN|||N|||F

Implementation Guide for Laboratory Results, U.S. Realm, HL7 Version 2.5.1

EHDI CDA Pilot Project

EHDI CDA Pilot Project

• The HIT Standards Federal Advisory Committee has

recommended the use of the HL7 CDA standard as a

future direction for electronic data exchanges between

clinical and public health information systems for public

health reporting

• The Public Health Data Standards Consortium (PHDSC) is

demonstrating electronic data exchange between clinical

EHR Systems and public health EHDI using the HL7 Clinical

Document Architecture (CDA) standard

EHDI CDA Pilot ProjectGoal: demonstrate the ability to receive a CDA-based EHDI Report by a Public Health Information System in two jurisdictionswill focus on reporting of:

• Newborn hearing screening results and basic patient demographics from the birthing facility’s EHR to the State EHDI Program

or• Early Hearing Care Plan (EHCP) - based on

jurisdictional plans

Health Information Exchange

(HIE)

Or

Public Health

Gateway

Birthing Facility

EHR

Screening Results

Document State EHDIInformation

System

CDA-based Actor Diagram

CDA EHDI Pilot Project DesignProposed Public Health Reporting Schema: Screening Report

Screening Results

Document

Health Information Exchange

(HIE)

Or

Public Health

Gateway

State EHDIInformation

System

Early Hearing

CarePlan Primary Care

Provider EHR

CDA-based Actor Diagram

CDA EHDI Pilot Project DesignProposed Public Health Reporting Schema: Care Plan

Early Hearing

Care Plan

TEAM

2 States Participants: (to be determined)• Maryland, Massachusetts, Michigan, North

Dakota, Oregon, Rhode Island

States Observers• Florida, Missouri, Ohio, Pennsylvania, South

Carolina, Texas, Washington

PHDSC Team:• Alla Fridman, Anna Orlova, Lisa Nelson, Lori

Fourquet, Maiko Minami, Sarah Quaynor

CDA EHDI Pilot Project: Team

• Aug - Sept– Recruitment• 2 State participants (To be determined)• X State observers

• November 2012 – Pilot Design• December 2012 – Implementation• January 10, 2012 – Testing• February, 2013 – Draft Project Report• May 2013 – Final Project Report

CDA EHDI Pilot Project: Timeframe

CDA EHDI Pilot Project informationPHDSC Project Wiki pages at:

https://wiki.phdsc.org/index.php/EHDI

The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position or policy of the Centers for Disease Control and Prevention.