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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] [email protected] [email protected] [email protected] 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.