Minnesota Newborn Screening Program Amy Gaviglio, MS, CGC

1. Timeliness and Point-of-Care Newborn Screening: Statewide Implementation of Electronic Demographics and Result Reporting Minnesota Newborn Screening Program Amy Gaviglio, MS, CGC

2. Newborn Hearing Screening • Occurs 12-48 hours after birth • Results reported to the Dept of Health • Typically reported via the newborn screening bloodspot card • Manually entered onto the card and manually transcribed into LIS • Left Ear/Right Ear; Pass/Refer

3. Newborn CCHD Screening • Occurs >24 hours after birth • Results reported to the Dept of Health • Pass/Fail at individual level • Raw O2 sat values and Pass/Fail at individual level • Aggregate data at facility level

4. Timeliness Earlier detection = earlier intervention = better outcomes

5. Why Electronic Reporting? • Experience with Hearing Screening • Process involved a number of manual steps • >3500 unreported results/year • Inaccurate results • High programmatic costs ($45,000+ annually) • Unnecessary follow-up or missed follow-up

6. Hearing Screening Process

7. Why Electronic Reporting? • Experience with CCHD Pilot • Misinterpretation of algorithm • Babies discharged home who failed the screen, vice versa • Likelihood of algorithm to change • Unreported results

8. Algorithm

9. Project Scope • Obtain newborn demographics directly from the EMR • Obtain EHDI results directly from the screening device • Obtain raw and individual-level CCHD results directly from the device or at the time of screening to allow for clinical decision support FUNDED THROUGH FEE INCREASE

10. OZ Systems Step 1 Step 2 Step 3 Integrated Newborn Record NANI™ (ADT Feed) Telepathy EHDI™ Telepathy CCHD™ (HL7 Messages)

11. Current Project Approach Training Scheduled and Completed ADT Feeds Built, Tested, and Devices Connected Post-Go Live Monitoring Go Live Date Selected Kick Off Webinar GO LIVE MDH OZ Systems IT Staff Nursing Staff MDH OZ Systems Interface Team Biomed Team Nursing Staff MDH Nursing Staff MDH MDH OZ Systems Interface Team Biomed Team Nursing Staff

12. Estimated Birth Coverage* By Status Production/Ongoing Submission: 90.7% Active Engagement: 9.3%

13. Outcomes: Hearing Screening Better quality results are available days earlier

14. Outcomes: CCHD Screening • Pilot study showed that 29% of retests or Echocardiograms were due to inaccurate interpretation of the algorithm. • Preliminary 2016 data indicate that only 7% of retests were due to mis-interpretation. No unnecessary Echos have been ordered.

15. Observations • Post-production monitoring necessary when project involves workflow changes • Electronic reporting does not solve all timeliness and data problems • Serial screening, mis-entry into EMR, etc.

16. Next Phase(s) • Continue implementation • Current goal is all hospitals live by 11/01/2016 • Sending EHDI/CCHD results back to EMR • Audiology electronic reporting into MNScreen • Further interoperability

17. Why does it matter? • Increased data integrity • Increased efficiency • Increased timeliness • Improved QI/QA abilities • BETTER OUTCOMES

18. Thank You! MNScreen Team: Kaitlin Houlihan Kirsten Coverstone Amy Gaviglio OZ Systems Rebecca Johnson amy.gaviglio@state.mn.us