presented by: Kathryn Perko Aveni, RNC, MPH Research Scientist, EHDI Program co-author:

1. Utilizing a Statewide Immunization Registry for EHDI Tracking and Reporting2007 National EHDI Meeting Salt Lake City, UtahMarch 26, 2007 presented by: Kathryn Perko Aveni, RNC, MPH Research Scientist, EHDI Program co-author: Zina Kleyman NJIIS Project Manager New Jersey Department of Health and Senior Services

2. Faculty Disclosure Information In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation. This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA.

3. New Jersey Immunization Information System (NJIIS) • Developed in 1997, web enabled since May 2002 • September 2, 2004 – Governor signed Immunization Registry Act • NJIIS was twice recognized by Centers for Disease Control and Prevention • October 27, 2003 - Connect Award • October 18, 2004 - Grow Award • October 2006 – named Best Practice of the Month by American Immunization Registry Association

4. NJIIS Primary Purposes • Provide current recommended immunization schedule for all age groups • Consolidate immunization information from all providers into one record to provide an accurate immunization assessment • Eliminate the use of manual vaccine administration logs

5. NJIIS Primary Purposes • Ensure access to preventive health/screening information such as immunization, Flu, TB, Lead and Newborn Hearing Screening • Help communities assess their immunization coverage and identify pockets of need

6. NJIIS Technical Environment • Technology Components • J2EE for middleware on Weblogic server v8.1 • Oracle 9i for database • JSP/HTML for presentation • XML for data interfaces with external systems • Infrastructure Components • Intel-Xeon platform • Windows 2003 servers

7. NJIIS User Environment NJ State BATCH PROCESSES Electronic Birth Certificates demographic and immunization records from Medicaid and WIC. Lead and Newborn Hearing screening EMR, Billing INTERNET NJIIS Immunization Records Schools, Daycares etc Physicians MCO, HMO Clinics, Long-term healthcare facilities Local Health Departments Hospitals Data Entry and Reports Saturation Measures and Immunization Coverage Reports

8. NJIIS Statistics • 450 Providers • 1,100,000 Patients • 10,000,000 Doses Every month • 7,000 Patients are loaded from EBC • 4,500 Patients are entered through on-line interactive data entry via Web • 100,000 Doses are entered through on-line interactive data entry via Web • 25,000 Doses are loaded electronically from Medicaid, EMR and billing systems

9. NJ EHDI – History • 1977: Law required “evaluation” of newborns for hearing loss • 1980: Hospitals sent paper forms to DHSS for babies with risk indicators for hearing loss • 1994-1997: Risk indicators & screening results (if done) now reported via EBC • 2002: Law required universal newborn screening. Inpatient results & risks reported via EBC, outpatient results on paper form

10. NJ EHDI - Registry Law includes: • “The commissioner shall establish a central registry of newborns…. for the purposes of compiling statistical information and providing follow-up counseling, intervention and educational services…” • “A…professional who performs testing …shall report the results…in a manner and on forms prescribed by the commissioner.” 2002: EHDI database developed using Microsoft Access. EBC records populate database. Paper forms with outpatient test results data entered by DHSS Clerk.

11. NJ EHDI - Statistics 2005 occurrent births (110,836 births): • Screened either before d/c or by 1 mo: 99.0% • Refer on final inpatient screening: 3.8%* • Oupatient f/u on refers (rescreen or dx testing): 58.9%* • Timely f/u (by 3 months): 44.1% • Diagnosed w/ HL: 1.04 per 1000 births • In EI by 6 mo: 37.7% of babies dx w/ HL *Over 7500 paper outpatient follow-up reports submitted for 2005 births

12. NJIIS & EHDI Partnership Why: • Allow electronic Web-based reporting by providers doing rescreening and diagnostic testing • More timely • Avoid duplicate and cumbersome writing of demographic information • Avoid errors & incomplete reports • Ability to view previous results • IIS system already in place – cheaper and easier than building an EHDI Web system • Pediatricians can check status of immunizations and hearing in one system

13. NJIIS & EHDI Partnership How: • NJIIS in Division of Epidemiology, Environmental and Occupational Health • EHDI in Division of Family Health Services • Preliminary meetings to discuss goals • Memorandum of Agreement (MOA) signed by assistant or deputy commissioner over each Division • Transfer of funds from CDC & HRSA grants

14. Project Timeline • Spring 2006: MOA developed, EHDI forms & other specifications provided to NJIIS • Spring-Summer 2006: NJIIS Programming • Aug. 2006: Beta testing by EHDI program • Sept. 2006: • Inpatient screening results viewable to PCPs • 4 facilities volunteered as pilot test sites for entering outpatient results • Dec. 2006: Began full roll-out/user training

15. System Overview

16. Home Page http://njiis.nj.gov

17. Administrative login

18. Address info used to auto fill facility address on reports EHDI data coordinator has admin access to IIS system to add “EHDI Providers” Provider Setup

19. EHDI data coordinator also adds “EHDI Users” System access can be revoked by simply checking box User Setup

20. EHDI Users can be assigned to multiple facilities: practice with several offices, user w/ 2 part-time jobs User/Provider Setup

21. EHDI User login

22. User Login

23. User starts by selecting the facility they are reporting from (if work at >1 facility) Provider Choice

24. User can choose to search with child info, identifiers or mother’s name Search - Identifiers

25. Search – Child Name/DOB

26. Search Results can be re-sorted by any column. In this example the results are re-sorted by Birth date. To re-sort the list click on column title

27. Patient Information Page EHDI Users have access to only certain tabs (aliases, & addresses, but not immunization and med hx)

28. Aliases AKAs can be entered and are used in generating search screen results

29. Relatives/Addresses Alternate guardians can be added. Address/phone number info can be updated

30. Patient Information Page Hearing Screening link is only active for “EHDI Users” and Pediatricians who have “claimed” PCP status for child

31. Audiology Facility of Record EHDI Users are asked to note if they are “primary” audiology follow-up facility for purposes of reports

32. EHDI Summary Page Initially displays risk info and inpatient screening results from EBC

33. Clicking an exam date on the summary page opens full report EBC system includes some HL risk indicators

34. EHDI Summary Page Summary of outpatient follow-up is added as forms are completed in the system Buttons at the bottom of the screen are clicked to start a new outpatient follow-up report

35. Demo-graphic section is auto-filled with information already stored in the NJIIS system Reason for testing also auto-fills Facility name & address is auto-filled based on user login

36. Risk Indicators Pop-up Box

37. Test result sections are mainly check boxes. Evaluator is pick list of people working at that facility. Phone auto-fills based on phone number stored in user setup

38. Saving form triggers data validation checks: • Must have exam date • Exam date must be > DOB • If dx HL must have type & degree • Etc.

39. Form can be printed after saving (to send copy to pediatrician) DHSS does not require a paper copy

40. Pediatricians have ability to view results and can generate a “lost” form. If doing testing in their office, they must be set up with “EHDI User” user names EHDI Summary Screen – Pedi User

41. Demographics auto-fill the same as with the follow-up report

42. Both Pediatricians and Audiologists have the ability to run reports for “their” patients

43. Report Sample

44. EHDI program in administrative section can create extract to export data to Excel

45. User Training

46. User Training • Several hospitals were asked to volunteer computer rooms. 4 hospital sites were used. • Medical Coordination Centers (MCC) • DHSS maintains 8 facilities throughout the state as response coordination centers for mass casualty incidents (bioterrorism, natural disaster, epidemic outbreak). 5 of these sites were used.

47. MCC Training Sites Hospital Training Sites User Training • New Jersey • 4th smallest state in US • 70 miles wide/150 miles long

48. User Training • Notification via email to hospital-based EHDI contacts and providers who previously submitted forms • Follow-up phone calls to large volume facilities that did not register promptly • Attendees received certificate for 3 continuing education hours that can be used for State audiology licensure requirements

49. User Training • A training version of system was used to allow “fake” data entry on “fake” children • Case studies were developed representing a variety of scenarios (rescreening, diagnosed hearing loss, lost to follow-up, out-of-State birth, etc.) • 7 scenarios X 15 users • 2 or 3 EHDI-team members were at each location to allow for room roaming/troubleshooting

50. User Training December 13, 2006 – February 28, 2007 • 12 sessions held at 9 sites (am & pm at some sites) • Between 6 and14 users were signed up for each session • Staff from 42 hospitals/audiology facilities trained • 117 users trained • audiologists, techs, secretaries, maternity dept. staff • Some additional users will be trained by co-workers who attended training sessions • A couple additional sessions will be offered in May, then probably annually The EHDI program is grateful for a very mild NJ winter 