Shan He, PhD Intermountain Healthcare

1. Implementing Automated Data Reporting to Improve Early Hearing Care S116: Methods for Enhancing Public Health Surveillance with EHR Data Shan He, PhD Intermountain Healthcare

2. Disclosure • I have no relevant relationships with commercial interests to disclose. AMIA 2017 | amia.org

3. Introduction • Hearing loss is one of the most common birth defects (1 out of 300 babies) • The first months and years of life are a critical period for brain development. • Early identification of hearing loss and appropriate intervention ensures a child will have the opportunity to reach their maximum potential source: http://health.utah.gov/cshcn/programs/ehdi.html AMIA 2017 | amia.org

4. Early Hearing Detection and Intervention (EHDI) LTD Public Health Healthcare Provider Test for congenital CMV Outpatient Hearing Screening Discharge Newborn Hearing Screening Child Birth Repeat Hearing Screening fail fail fail LFU Diagnostic Hearing Evaluation Day 21 3 months Day 1 Day 2 Day 3 Day 14 LFU: loss to follow-up; LTD: loss to documentation AMIA 2017 | amia.org

5. Background • 2014 Annual EHDI data indicate about 34% of infants were considered as LFU/LTD1 • Utah: 13% of infants were considered as LFU/LTD 1Source: Summary of Diagnosis and Loss to Follow-up / Loss to Documentation in 2014 https://www.cdc.gov/ncbddd/hearingloss/ehdi-data2014.html AMIA 2017 | amia.org

6. Objective • Enable real-time, electronic diagnostic hearing data reporting to the State EHDI program • Implement a solution with low budget by leveraging existing Health Information Exchange (HIE) infrastructure AMIA 2017 | amia.org

7. Methods • Develop decision support rules to capture the diagnostic evaluation event in real-time • Generate a standard C-CDA document with embedded diagnostic evaluation report and lab results • Send the C-CDA document to the State EHDI program using Direct email AMIA 2017 | amia.org

8. Data Flow Overview AMIA 2017 | amia.org

9. Decision Support Triggers Data-driven • Storage of a CMV lab result • Finalized documentation of a diagnostic evaluation report • Audiology Assessment/Reassessment • Audiology Audiogram Report, Pediatric • Audiology External Medical Information, Pediatric • Audiology Auditory Brainstem Response Report, Pediatric • Audiology Assessment • Audiology Consult • Audiology Evaluation Report, Pediatric • Audiology Oto Acoustic Emissions Report, Pediatric • Audiology Initial Evaluation Report • Audiology Progress Report, Pediatric • Audiology Initial Evaluation Report, Pediatric • Audiology Tympanogram Report, Pediatric 1 2 3 AMIA 2017 | amia.org

10. 1 2 3 C-CDA Generation • Why C-CDA Progress Note • Industrial standard for document-based health information exchange • Existing C-CDA implementation infrastructure in place at Intermountain • Progress Note is clinically suitable • The C-CDA Progress Note can accommodate all information for this use case without requiring other irrelevant data types • Assessment and Plan section—diagnostic report as image • Results section—CMV lab results AMIA 2017 | amia.org

11. Embedded free-text report in C-CDA AMIA 2017 | amia.org

12. 1 2 3 Document Transport • Direct • Secure, easy-to-use, inexpensive • Existing Direct infrastructure implemented at Intermountain • A Direct address was provisioned for EHDI by the state HIE • Content sent as XML and rendered in human readable format • Easy to parse, ready to be integrated with the HiTrack system as the next step AMIA 2017 | amia.org

13. Results AMIA 2017 | amia.org

14. Results AMIA 2017 | amia.org

15. Results • Timeframe: 10/01/2016—09/30/2017 • 4,421 C-CDA documents sent from Intermountain to UDOH • 2,236 unique patients • 7% (158/2,236) of patients have both CMV and Audiological Note triggered C-CDA documents AMIA 2017 | amia.org

16. Results Number of C-CDA documents Month AMIA 2017 | amia.org

17. Results Number of C-CDA documents Age Group AMIA 2017 | amia.org

18. Results Frequency Number of C-CDA Hearing Documents per Patient AMIA 2017 | amia.org

19. Outcome/benefits • Reduced the LTD rate to near zero for Intermountain facilities • from 12 reports/month (fax) to 368 reports/month (electronic) • Decrease in LTD will impact the LFU, which in turn impacts early identification • Faster intervention possible from EHDI • Utah EHDI Program was able to quickly identify a child that received the wrong CMV test and contact the Primary Care Provider to conduct the right test within the 21 day time frame for proper treatment AMIA 2017 | amia.org

20. Limitations • Non-structured data for the diagnostic audiology notes in C-CDA • IHE Early Hearing Care Plan (EHCP) Profile under development • Disconnection between the C-CDA documents received via Direct and the HiTrack system • Lack of a formal evaluation of the completeness and timeliness of the electronic reporting AMIA 2017 | amia.org

21. Yesterday… LTD Public Health Healthcare Provider Test for congenital CMV Outpatient Hearing Screening Discharge Newborn Hearing Screening Child Birth Repeat Hearing Screening fail fail fail LFU Diagnostic Hearing Evaluation Day 21 3 months Day 1 Day 2 Day 3 Day 14 LFU: loss to follow-up; LTD: loss to documentation AMIA 2017 | amia.org

22. Today… Public Health Healthcare Provider Test for congenital CMV Outpatient Hearing Screening Discharge Newborn Hearing Screening Child Birth Repeat Hearing Screening fail fail fail LFU Diagnostic Hearing Evaluation Day 21 3 months Day 1 Day 2 Day 3 Day 14 AMIA 2017 | amia.org

23. Tomorrow… Public Health Healthcare Provider Test for congenital CMV Outpatient Hearing Screening Discharge Newborn Hearing Screening Child Birth Repeat Hearing Screening fail fail fail Diagnostic Hearing Evaluation LFU Day 21 3 months Day 1 Day 2 Day 3 Day 14 AMIA 2017 | amia.org

24. Acknowledgement • Sidney N. Thornton, PhD, Intermountain Healthcare • Darren Mann, Intermountain Healthcare • Christine Perfili, MBA, Utah Department of Health • Krysta Badger, Utah Department of Health • Matt Hoffman, MD, Utah Health Information Network • Viral Shah, Intermountain Healthcare • Gary Anderson, Intermountain Healthcare • Rishabh Bhatia, Intermountain Healthcare AMIA 2017 | amia.org

25. Thank you! shan.he@imail.org