Washington's Experience with a Web-based Diagnostic Data Collection Application

1. Washington’s Experience with Using A Web-based Application to Collect Diagnostic Data Karin Neidt, MPH

2. Objectives • Give background information on Washington State’s EHDDI program and the development of our system • Describe the web application used to collect data from audiologists and how it’s being used • Share what our experience has been with the application and our plans for the future

3. Washington State Profile • ~ 80,000 births • 69 birthing hospitals – all have UNHS programs • No mandate for hearing screening • Use revised blood spot card • 66 hospitals submitting data to the EHDDI program

4. Hearing Screening Rates Reported by Hospitals *Hearing screening rate obtained from screening results reported to EHDDI (does not include military hospitals).

5. Hospitals -birth rosters -dried blood screen -hearing screen results DOH Office of Newborn Screening -process all cards EHDDITracking and Surveillance System Primary Care Provider Audiologist Patient

6. System Follow-up Protocols • Timed to achieve 1-3-6 goals • Monitor that each infant receives a hearing screen • Recommend appropriate follow-up care through primary care provider • Collect diagnostic information from audiologists through a web-based application (Phase II) • EHDDI staff requests results on referred patients quarterly

7. A Little History

8. Phase II Development • 2000: Received CDC and HRSA Grants • 2001: Built tracking and surveillance system (Phase I) • 2002: Began work on web-based application for audiologists (Phase II) • 2003: Piloted web application with audiologists • 2004: Web application went live • 2005: System was upgraded based on feedback from audiologists

9. Why A Web-based Application? • Convenient way to report information • Audiologist can control information on their patients - accuracy • Can offer tools for audiologists • Secure environment

10. DOH VB CLIENT Audiologist Web App System Overview Birth Rosters Newborn Screening Demographic Data Hearing Screening Results .ASP pages EHDDI SQL DATABASE EHDDI Staff Audiologist

11. Digital Certificate • Electronic method of signing and encrypting electronic messages or documents • Costs $100 initially, with $34 renewal fee • Application process to receive certificate

12. Screen Shots of The Application

18. Audiologists Reporting to EHDDI • 19 clinics meet best practices for audiologic assessment of infants • 13 audiology clinics use web application to report diagnostic results • Results from 38 clinics have been entered into the system

19. Data From Phase II Since 2002 • 2011 audiologic visits recorded in system • 1516 patients • ~420 patients diagnosed with hearing loss since 2002

20. Percent Patients With Demographic Data Reported • 3% Mother’s Date of Birth • 7% Mother’s Race/Ethnicity • 13% Primary Language • 36% Mother’s Address • 39% Patient’s insurance was indicated

21. Reporting of Risk Factors • 16% of patients with visit were indicated as having one or more risk factor • 459 risk factors reported by audiologists • 41% NICU • 18% Family History • 15% Craniofacial anomalies • 13% Parental or caregiver concern • 12% Other • 1% Maternal Illness

22. Syndromes Reported by Audiologists

23. Percent of Visits with Diagnostic Test Results Reported • Physical Examination – 60% • Behavioral Test Section – 10% • Physiologic Test Section • Tympanometry – 80% • OAE performed – 71% • Result indicated – 97% • ABR performed – 60% • Click threshold indicated - 85%

24. Hearing Loss Reported by Audiologists • 99% of audiology visits had hearing loss section completed (Yes/No/Undetermined) • For those visits when hearing loss was present • 89% Degree of hearing loss completed • 87% Type of hearing loss completed • 42% Configuration of hearing loss completed

25. Referrals Reported by Audiologist • 70% of patients in the system had reported follow-up recommendations • 52% Further evaluation (referred/kept in) • 39% Discharge • 26% Audiologist • 24% ENT • 13% Behavioral Evaluation (3 or 6 months) • 11% Early Intervention • 8% Physician • 5% Genetics • <1% Neurologist

26. Internal Reports for Audiology Clinics Patient related reports Facility reports Can Generate Follow-up Tasks for Clinics Are they being used?? Functions to Assist Clinics

27. Disadvantages of Web-Application • All data elements are not currently being captured • Data entry requires time from audiology clinics • Requires some computer savvy • Application process for digital certificate and installation of application can take time and prove challenging for clinics • Clinics without digital certificates cannot report via application • Costs of making changes to web application

28. Benefits of Web Application • Allows audiologists to accurately report and review diagnostic information for patient visits • Web application is easy to access • It’s a secure way of reporting patient information • Offers tools for clinics • Does not waste resources from faxing or mailing results • Has the potential to collect many data elements

29. Future Plans • Meeting with pediatric audiologists to: • Report data collected from Phase II • Request their input on how they are using the system • Discuss improvements that could be made • Review Best Practices Guidelines • Restructure Phase II for easier use • Increase the number of pediatric audiologists using Phase II • Explore mechanisms to link with early intervention

30. Contact Information EHDDI Program Department of Health Office of Newborn Hearing Screening 160 NE 150th St. PO Box 55279 Shoreline, WA 98155 Ph: (206) 418-5613 Fax: (206) 418-5415 www.doh.wa.gov/ehddi