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EHDI Content Profile:
Screening, Short-Term Care, and
Clinical Surveillance for Hearing Loss
John Eichwald, MA FAAA
CDC EHDI Team Lead
Terese Finitzo, PhD
CEO OZ Systems
Public Health Data Standards Consortium
Anna Orlova, PhD
Executive Director
Public Health Data Standards Consortium
Lori Reed-Fourquet, MS
e-HealthSign, LLC
Integrating the Healthcare Enterprise®
(continuous
monitoring)
Newborn
Hearing
Age < 36
months
Medical Home
PCP EHR-S
Pass NHR
(no)
(yes)
Screening:
(no)
Hospital EHR-S
Pass HR
(no)
HS
Device
risk
analysis
EHCP
(yes)
Appointment
Kept?
Fail / Refer
(24 – 36 months)
(yes)
Public
Health
EHDI-IS
Not Complete
Audiology
Appointment
(no)
Kept?
(yes)
Diagnosis
OP screen
EHCP
(fail)
(pass)
Hearing Loss
Normal
Pass/Fail
(no)
(yes)
Eligibility
Early Intervention
EHDI Content Profile - Process Flow
Close
Close
(continuous
monitoring)
Newborn
Hearing
Age < 36
months
Medical Home
PCP EHR-S
Pass NHR
(no)
(yes)
Screening:
(no)
Hospital EHR-S
Pass HR
(no)
HS
Device
EHCP
risk
analysis
(yes)
Appointment
Kept?
Fail / Refer
(24 – 36 months)
(yes)
Not Complete
Public
Health
EHDI-IS
Audiology
Appointment
(no)
Kept?
(yes)
Diagnosis
OP screen
EHCP
(fail)
(pass)
Hearing Loss
Normal
Pass/Fail
(no)
(yes)
Eligibility
Early Intervention
Close
Use Case 1 : Birthing Facility Hearing Screening
Close
(continuous
monitoring)
Newborn
Hearing
Age < 36
months
Medical Home
PCP EHR-S
Pass NHR
(no)
Close
(yes)
Screening:
(no)
Hospital EHR-S
Pass HR
(no)
HS
Device
EHCP
risk
analysis
(yes)
Appointment
Kept?
Fail / Refer
(24 – 36 months)
(yes)
Public
Health
EHDI-IS
Not Complete
Audiology
Appointment
(no)
Kept?
(yes)
Diagnosis
OP screen
EHCP
(fail)
(pass)
Hearing Loss
Normal
Pass/Fail
(no)
(yes)
Eligibility
Early Intervention
Close
Use Case 2: Newborn Hearing Screening: Pass right; Pass left; No risk
factors
(continuous
monitoring)
Newborn
Hearing
Age < 36
months
Medical Home
PCP EHR-S
Pass NHR
(no)
(yes)
Screening:
(no)
Hospital EHR-S
Pass HR
(no)
HS
Device
EHCP
risk
analysis
(yes)
Appointment
Kept?
Fail / Refer
(24 – 36 months)
(yes)
Not Complete
Public
Health
EHDI-IS
Audiology
Appointment
(no)
Kept?
(yes)
Diagnosis
OP screen
EHCP
(fail)
(pass)
Hearing Loss
Normal
Pass/Fail
(no)
(yes)
Eligibility
Early Intervention
Close
Use Case 3: Newborn Hearing Screening not complete
Close
(continuous
monitoring)
Newborn
Hearing
Age < 36
months
Medical Home
PCP EHR-S
Pass NHR
(no)
Close
(yes)
Screening:
(no)
Hospital EHR-S
Pass HR
(no)
HS
Device
EHCP
risk
analysis
(yes)
Appointment
Kept?
Fail / Refer
(24 – 36 months)
(yes)
Public
Health
EHDI-IS
Not Complete
Audiology
Appointment
(no)
Kept?
(yes)
Diagnosis
OP screen
EHCP
(fail)
(pass)
Hearing Loss
Normal
Pass/Fail
(no)
(yes)
Eligibility
Early Intervention
Close
Use Case 4: Short-term Care Follow-up: Audiologic Diagnosis and
Referral to Early Intervention
(continuous
monitoring)
Newborn
Hearing
Age < 36
months
Medical Home
PCP EHR-S
Pass NHR
(no)
Close
(yes)
Screening:
(no)
Hospital EHR-S
Pass HR
(no)
HS
Device
EHCP
risk
analysis
(yes)
Appointment
Kept?
Fail / Refer
(24 – 36 months)
(yes)
Public
Health
EHDI-IS
Not Complete
Audiology
Appointment
(no)
Kept?
(yes)
Diagnosis
OP screen
EHCP
(fail)
(pass)
Hearing Loss
Normal
Pass/Fail
(no)
(yes)
Eligibility
Early Intervention
Close
Use Case 5: Clinical Surveillance Monitoring for Delayed, Progressive or
Incident-based Hearing loss
EHDI Quality Measurement Indicators
Measure: EHDI-1a (Use Case 1)
• Percent of births that have been screened for
hearing loss before hospital discharge
• Numerator = # newborns screened
• Denominator = # newborns discharged
Rationale: Benchmarks set within the EHCP may
trigger hospital or jurisdictional compliance
activities, such as rewriting of procedural
guidelines or retraining of screening staff
EHDI Quality Measurement Indicators
Measure: EHDI-1b (Use Case 1)
• Hearing screening refer rate at hospital
discharge
• Numerator = # newborns fail/refer
• Denominator = # newborns screened
Rationale: Benchmarks set within the EHCP may
trigger hospital or jurisdictional compliance
activities, such as retraining of screening staff or
recalibration of hearing screening devices
EHDI Quality Measurement Indicators
Measure: EHDI-1c (Use Case 3)
• Percent of infants not screened at birth who
receive outpatient screening no later than one
month of age
• Numerator = # newborns with outpatient screen
• Denominator = # screening not complete
Rationale: Benchmarks set within the EHCP may
trigger hospital or jurisdictional compliance
activities, such as rewriting of procedural
guidelines or retraining of screening staff and
healthcare providers
EHDI Quality Measurement Indicators
Measure: EHDI-2a (Use Case 2 - 5)
• Percent of infants within a Medical Home who
have completed risk factor analysis and
information has been transmitted to EHDI-IS
• Numerator = # analysis and transmitted
• Denominator = # patients < 12 months of age
Rationale: Depending upon jurisdictional
benchmarks, Public Health EHDI staff may review
EHCP for completion of risk assessment for
quality assurance
EHDI Quality Measurement Indicators
Measure: EHDI-2b (Use Case 2, 4, & 5)
• Percent of children in a practice with risk factor
and have an audiological diagnosis
• Numerator = # with documented audiological
diagnosis (24 - 36 mos.)
• Denominator = # patients in the practice 24 - 36
months with risk factor
Rationale: Public Health EHDI staff may review
EHCP for completion audiological diagnosis for
quality assurance
EHDI Quality Measurement Indicators
Measure: EHDI-3 (Use Case 4)
• Percent of newborns not passing screening who
have an audiologic evaluation no later than age 3
months
• Numerator = # audiological Dx < 91 days
• Denominator = # newborns fail/refer
Rationale: May trigger Public Health EHDI staff
compliance activities, such as rewriting of
procedural guidelines or educational activities for
health care providers
EHDI Quality Measurement Indicators
Measure: EHDI-4a (Use Case 4)
• Percent of infants with hearing loss referred to
intervention services no later than age 6 months
• Numerator = # referred to intervention with age
< 181 days
• Denominator = # diagnosis of hearing loss
Rationale: May trigger Public Health EHDI staff
compliance activities, such as rewriting of
procedural guidelines or educational activities for
health care providers
EHDI Quality Measurement Indicators
Measure: EHDI-4b (Use Case 4 & 5)
• Percent of infants with hearing loss referred to
intervention services within 48 hours of Dx
• Numerator = # referred to intervention < 3 days
• Denominator = # diagnosis of hearing loss
Rationale: May trigger Public Health EHDI staff
compliance activities, such as rewriting of
procedural guidelines or educational activities for
health care providers
EHDI SNOMED-CT Codes
Type of Hearing Loss:
Description
SNOMED
Permanent Conductive
44057004
Sensorineural
60700002
Mixed
77507001
Auditory Neuropathy Spectrum
Disorder
443805006
Transient Hearing Loss
123123005
EHDI SNOMED-CT Codes
Degree of Hearing Loss:
Description
SNOMED
Normal (-10 to 15 dB HL)
17621005
Slight (16 to 25 dB HL)
Mild (26 to 40 dB HL)
Moderate (41 to 55 dB HL)
Moderate-Severe (56 to 70 dB HL)
Severe (71 to 90 dB HL)
Profound (91+ dB HL)
255605001
18647004
6736007
371924009
24484000
255611003
Agreed upon by DSHPSHWA March 2010
Implementation January 2011
EHDI SNOMED-CT Codes
Laterality of Hearing Loss:
Description
SNOMED
Unilateral loss - right ear
419465000
Unilateral loss - left ear
419161000
Unilateral loss - ear unspecified
95819006
Bilateral loss
95820000
EHDI SNOMED-CT Codes
Referral:
Description
Referral to pediatric diagnostic
audiology service
Referral to education service - Early
Intervention (Part C/non Part C)
SNOMED
306210008
415271004
EHDI SNOMED-CT Codes
Follow-up:
Description
SNOMED
Infant died
397709008
Change of residence status
360885002
Patient address unknown
184112005
Patient telephone number unknown
184118009
Follow-up refused
183638004
Procedure refused-uncooperative
183946001
EHDI SNOMED-CT Codes
Follow-up (continued):
Description
SNOMED
Persistent non-attender
413319007
Loss to follow-up
399307001
Inconclusive
419984006
Appointment cancelled by patient
185332005
Appointment cancelled by doctor
185333000
Did not attend
281399006
EHDI IHE Integration Profile
Timeline:
•
June 1, 2010: EHDI Content Profile will be published
for public comment
• public comment period closes June 30
•
August 2010: EHDI Content Profile published for trial
implementation
•
January 2011: testing at IHE Connectathon
•
Spring 2011: demonstration at Healthcare
Information and Management Systems Society
(HIMSS) Interoperability Showcase
Questions?
[email protected]
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The findings and conclusions in this presentation have not been formally disseminated by
the Centers for Disease Control and Prevention and should not be construed to represent
any agency determination or policy.