Extending Our Reach Through Partnerships June 2-6, 2013 Phoenix, Arizona

1. Extending Our Reach Through PartnershipsJune 2-6, 2013 Phoenix, Arizona

2. Advancing e-Birth Records: Minnesota’s Experience Kari Guida, MPH, MHI Senior Health Informatician Minnesota Department of Health

3. Acknowledgements • Unity Hospital: Cheri Clough, Marcia Hauck, Stacy Hanson, Lori Wightman, Maggie Borer • CDC/NCHS: Michelle Williamson, Delton Atkinson • MN.IT: Otto Hiller, Naz Hamdan, Brenda Gabriel, Kathy Grantham • MDH: Steven Elkins, Martin LaVenture, Behnoush (Sidney) Salehi, Sally Almond, Cindy Coleman, Cheri Denardo, Jennifer Fritz, Priya Rajamani, Heidi Granlund

4. Topics • Study Overview: Background, Approach & Methods • Preliminary Findings & Observations • Discussion • Next Steps

5. Study Overview • Evaluate the readiness for secure electronic exchange of birth records information from hospitals’ EHR to the Minnesota Department of Health (MDH) • Integrating the Healthcare Enterprise (IHE) Birth and Fetal Death Reporting (BFDR) Profile • Health Level 7 (HL7) standard message and document specifications • Make recommendations MDH, hospitals, NCHS and partners regarding standards-based exchange of birth record information. • September 2012 – December 2013

6. Study Background • The Minnesota Registration & Certification System (MR&C), a web-based system for vital records and certificate issuance was implemented in 2011. • Gaps and needs identified: • Quality of the data and workflow efficiencies • Interoperability between the state and hospitals’ EHRs during the abstraction and exchange. • Most (96%) of Minnesota hospitals have an EHR.

7. Minnesota Department of Health, Office of Health Information Technology, AHA Annual Survey (2012) Response Rate: 92% (136 of 148)

8. e-Birth Records Approach: Partnerships • Established a Collaborative Team • Office of Vital Records, Office of Health Information Technology, MN.IT at MDH and CDC/NCHS • project manager, business/program experts, information technology experts, health informaticians and project sponsors • Fostered Stakeholder Engagement • Partner Hospital • Advisory Group (MN e-Vital Records) • Community of Interest • Ongoing outreach to MDH, EHR/HIT vendors, and others

10. Minnesota’s Birth Record Information Flow

11. Preliminary Results 2013 IHE Connectathon • Developing the MN Birth Record Information flow engaged partners and created understanding of significance of the birth records data. • The proof of concept achieved mapping of 31 percent of medical data elements from the IHE BFDR Profile to the EHR. • Stakeholders are excited for standards-based exchange.

12. Unity Hospital’s Current Birth Record Process

13. Preliminary Results • Analysis of the partner hospital’s birth records process identified multiple challenges including: • duplicate data entry • medical information captured in text fields, discrete fields and scanned documents • time and effort to obtain birth data from multiple electronic and paper sources • lack of integration of prenatal care data into the EHR • Integration of prenatal care data into the EHR is influenced by: • relationship between prenatal care provider and hospital • hospital policy and workflow

15. Discussion • Address variations of all data sources for birth information is critical. • Implementation of the IHE BFDR Profile depends on availability of data, quality of data, and birth records process workflow. • The IHE BFDR Profile can increase workflow efficiency and improve data quality, but review by hospital staff is necessary.

16. Discussion • Achieving complete mapping of the IHE BFDR Profile data elements to the EHR is essential. • States and hospitals need technical assistance and resources for workflow, policy, information technology, organizational/leadership, data quality and informatics. • Collaboration between federal and state government, hospitals and EHR/HIT vendors is key to achieving standards-based exchange of birth records.

17. Study Next Steps • Reconcile variation between data sources. • Assess MDH’s & Unity Hospital’s readiness for HL7 standards. • Develop a model of future standards-based exchange of birth records for both MDH and hospital. • Make recommendations to MDH, hospitals, NCHS and partners for standards-based exchange of birth record information  

18. Important Steps to Advance e-Birth Records Nationwide • Create a “Roadmap for Implementation” for states and hospitals. • Develop toolkits, tips and templates to address training, organizational and technical issues. • Grow the understanding of need and opportunity for standards-based exchange for birth records.

19. Important Steps to Advance e-Birth Records Nationwide • Support pilot projects of standards-based exchange between states and hospitals, using IHE BFDR Profile and HL7. • Advance and support national and state e-vital records workgroups and/or advisory groups. • Engage additional EHR and HIT vendors. • Support vital records inclusion into Meaningful Use Stages 3 and beyond.

20. Contact Information Kari Guida, MPH, MHI Senior Health Informatician Minnesota Department of Health Kari.guida@state.mn.us 651.201.4136 www.health.state.mn.us/e-health/index.html