Linking Newborn Screening to Electronic Health records

MENA NBS DD conference, Doha, Qatar April 29th 2010April 29 2010Kari KlossnerDirector, Market and Sales Development

11 © 2009 PerkinElmer© 2009 PerkinElmer© 2009 PerkinElmer© 2009 PerkinElmer

My Topics

Overview of EHRs, HL7 and how they can benefit NBSPractical considerations in this fieldLessons learnedLessons learnedQ&A

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EHR HL7 and NBSEHR, HL7, and NBS

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What is an EHR… (also electronic / computerized patient record)

A textbook definition from Wikipedia.com

An EHR is… a collection of electronic health information about individual patients or populations. It is a record in digital format that is capable of being shared across different health care settings… Such records may include… demographics, medical history, medication and allergies, immunization status, laboratory test results,

di l i d billi i f tiradiology images, and billing information.

An EHR is… and maintained within an institution, such as a hospital, integrated delivery network, clinic, or physician office

The purpose is… a complete record… allows to automate and streamline workflow p p pin health care settings and to increase safety through evidence-based decision support, quality management, and outcomes reporting

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Why EHR – Key motivations to invest

Reduce costsElimination of duplicated effortsReduction of errors

Improved quality of careCan reduce medical errors by providing HC workers with decision support.F t t di l lit t & b t ti i h lth ffi

Promote evidence based medicine

Fast access to medical literature & best practices improve healthcare efficacy.

Promote evidence-based medicineEHRs give access to unprecedented amounts of clinical data for research Can accelerate the level of knowledge of effective medical practices.

Support record keeping and mobilityEHR’s can connect to many electronic medical record systems. In the current global medical environment patients are shopping for their procedures

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In the current global medical environment, patients are shopping for their procedures.

Introduction to EHR and HL7

HL7 is an organization Founded 1987, HQ in Ann Arbor, MI, USA, Non profit, ANSI-accredited standards development organizationE h i t ti h i d t i l f l t i h lth Exchange, integration, sharing, and retrieval of electronic health information> 2,300 members worldwide> 500 corporate members… > 90% of healthcare IT vendorsp

Name (Health Level 7) refers to the application level of the ISO seven layer communications model

HL7 is a language, a standard… an IT tool Allows for non compatible IT systems exchange information in a standard manner

HL7 is what is used to achieve interoperability in healthcare

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Interoperability in newborn screening

Where can newborn screening realize the greatest benefits?

R lt

Birthing center NBS Lab HC Provider

DemographicsResultsRecommendationsRequests

Manual manipulation of data = Opportunity to apply interoperability

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Change in process… the Old Way vs the New Way

Bi thi t Bi thi t1. Sample is taken2. Demographics are recorded3. Blood card is mailed to the lab

Birthing center1. Sample is taken2. Demographics are recorded3. Blood card is mailed to the lab

Birthing center

Newborn Screening Lab Newborn Screening Lab4. Blood card is received at the lab5. Information is recorded into computer6. Analysis is performed

Newborn Screening Lab4. Blood card is received at the lab

5 A l i i f d

Newborn Screening Lab

Opportunity for Human

(Entry automated via interoperability)

y p7. Report is printed8. Report is mailed to provider

5. Analysis is performedError

Redundant, non value

(Reporting automated via interoperability)

ReportReport

9 Report is receivedHC Provider HC Provider

non value adding,

repetitive work

ReportReport

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9. Report is received10. Information is recorded into computer11. Results are communicated to family 6. Results are communicated to family

ELIMINATED(Receiving automated via interoperability)

The challenge is shared and seen by many….

Test panels are very different

Differences in regional practices & regulations

Solutionstailored to

p yTesting and reporting methods differ customer to customerThere are no blood card data or format standards tailored to

customer specific needs Developing interoperability standards needs

Universal electronic coding and transmission standards are just now becoming available (HRSA / NLM)

99 …but solutions are different and diverse9

Practical considerations on on EHR/HL7interoperability in NBSp y

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Key goals for laboratories to pursue with EHR interoperability

Statistical accuracyStatistical accuracyLaboratory efficiencyReduce

Demographic data entry errorsTime spent in data entryTurn around time

Increase

Typically, following areas of application considered:

Turn around time

D hi iResultsRecommendations

Laboratory

nd

ndDemographic importTesting requests

RecommendationsRepeat requestsFollow-up ST & LTBilling

Inbou

n

Outbo

un

1111

Highlighting a few real life g g gexamples…

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Leeds, UK

British Columbia, Canada

Inbound/Outbound

Alberta, Canada

Outbound only

Go-live 2Q 2010 Inbound + Outbound

xChange, HL7 v3 Integration with NHS Spine

Inbound/Outbound Customized solution, HL7 v2.3

Integration with a HIMS

Customized solution, HL7 v2.2 Integration with provincial health

network

Integration with NHS Spine

Zurich, Switzerland

Go-live 2H 2010 Go-live 2H 2010 Inbound + OutboundxChange, HL7 v2.2

Integration to national hospital network

Ohio, USAKentucky, USA Illinois, USA

Go-live 2Q 2010 Inbound + Outbound

Customized solution, HL7 v2.3 (upgrade to v2.5.1 + HITSP IS

92 NBS t d d ) I t ti

Go-live 2Q 2010Outbound only

xChange, HL7 v2.5.1HITSP IS 92 NBS standards,

Requirements gathering Inbound + Outbound xChange, HL7 v2.5.1

Use HITSP IS 92 NBS

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92 NBS standards), Integrations with multiple hospital information

systems

S S 9 S s a da ds,Integration with state health

information exchange

Use S S 9 Sstandards (proposed)

Integrations TBD

Typical NBS Interoperability Architecture – Big Picture

Laboratory Information System Interoperability Layer

Outbound Message

Procedure

Outbound Messages

Table

Message Triggering

EventLIMS Vendor’s

Service

EHRSystem Data Tables

Partner

Laboratory

Outsource

EHRSystem

Inbound Messages

Table

Inbound Message Procedure

Data Validation

Engine

LIMS Database

Typically a PRODUCTdeveloped by a commercial LIMS vendor

Typically regional health organization

e.g. NHS SPINE in UK

a PRODUCT, a SERVICE or a combinationdeveloped by aLIMS vendor, a

141414

Partner, or theLaboratory

Alberta – outbound only, laboratory managed messaging

Interoperability LayerLaboratory Information System

Outbound Message

Procedure

Outbound Messages

Table

Message Triggering

Event

EHRHL7 V2.2

System Data TablesPartner

Laboratory

EHRSystem

LIMS DatabaseP i i l H l h Provincial Health

NetworkCloverLeaf

151515

Kentucky – outbound only, partner managed messaging

Interoperability LayerLaboratory Information System

Outbound Message

Procedure

Outbound Messages

Table

Message Triggering

Event HL7 V2.5.1

System Data TablesPartner

OutsourceKHIE

LIMS DatabaseC l h f

HITSP IS* 92Interoperability

http://www.mirthcorp.com/

Commonwealth of Kentucky Health

Information Exchange

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* The Healthcare Information Technology Standards Panel (HITSP) Interoperability Specification (IS)

Leeds – bidirectional, partner managed messaging

Interoperability LayerLaboratory Information System

Outbound Message

Procedure

Outbound Messages

Table

Message Triggering

Event

NHS HL7 V3

System Data TablesPartner

Outsource

NHS Spine

Inbound Messages

Table

Inbound Message Procedure

Data Validation

Engine

LIMS DatabaseN i l H l h S i National Health Service

network backboneSmartWorks

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Leeds and the NHS Connecting for Health (CfH) program

P t f th UK N ti l H lth S t (NHS)Part of the UK National Health System (NHS)CfH goal: make EHRs available for all NHS patients

Anywhere in the country

BirminghamBristol

CambridgeCardiff

NewcastleGlasgowBy means of the NHS spine network

Pilot project: Leeds St. James Hospital

GlasgowLeeds

LiverpoolGreat Ormond Street

Central MiddlesexCarshaltonL i h

First step outbound dataGo live April 2010Second step inbound data

LewishamManchester

OxfordPortsmouth

Sheffield

Next roll out from region to countryGoal to connect all UK NBS labs to NHS net

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Key motivations* at St James’ to implement NBS interoperability

Much quicker data entryGet better data faster

Ensure every baby gets screened by checking against birth records

Safeguard SpeedMissing a baby would have- disastrous consequences - major financial liability

Efficiency AccuracyEliminate human

errors in transcription No printingNo envelopesNo stampspNo mailman

1919* Based on an interview with Dr. Mick Henderson, St.James’ Hospital, Leeds, UK

Lessons learned

All typical lessons learned from an IT project apply… cannot overstate the importance of:

Getting buy-in from stakeholders & key players

Laboratory

Submitter (hospital)Consultant(s) g y y p y

Setting right expectationsCreating a solid specificationProfessional execution and monitoring

Several key players all

have to work together

gHL7 integrator

LIMS vendor

HIMS vendor

Key Challenge: the submitters (hospitals) are key players but most of the greatest key benefits are realized on the lab side

Submitters may only see the cost side and can be reluctant to sing upHave to “sell” to submitters – “what’s in it for us”

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Benefits realized by the community

“HL7 increases the lab’s efficiency” 1,2

“The effects on turnaround time are huge” 1No postal delay for reporting results saves 2-3 days

Reduces the lab’s call volumeData transfers are automatic

“We know what babies haven’t had a newborn screen” 1,2

Birth records can be compared to blood cards received

“HL7 increases our data accuracy” 1,2

Validates and reduces the amount of manually entered demographic dataNo manual entry of results into downstream electronic systems

“Our data is more accessible” 1,2

Downstream systems offer 24x7 access to resultsDoctors can access patients’ results online, from almost anywhere

No manual entry of results into downstream electronic systems

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p , y

1. Shaina Archer, Genetic Counselor, Alberta Health Services, Edmonton, Alberta CA2. Graham Sinclair, Biochemical Geneticist, BC Children’s Hospital, Vancouver, British Columbia CA

What should you expect from your vendor…

• Support common messaging stds & xmission protocols• HIT SP IS92 for NBS, HL7, LOINC, SNOMED

Provide the best solution , , ,

• Maintain awareness of national and regional standards while meeting customer data exchange requirements

• Develop innovative solutions to interoperability challenges• Adhere to privacy laws and regulations

best solution available

t d • Adhere to privacy laws and regulations today

• Collaborate w/ interoperability standardization initiatives internationally and regionally

• Offer system architecture for common communication interface to products

Develop standardized

HRSA NLM

interface to products• Proactively make interoperability tools as features of

future product• Provide flexible interoperability capabilities

S d h i l i h

standardized solutions for

the future2222

• Support customer needs as their regulations changethe future…to stay flexible to meet customer expectations22

Summary

Interoperability hold great promise for NBSInbound dataOutbound data Safeguard Speed

Key benefits can be realized several areas……

Safeguard Speed

EHR is the other party your lab connects with

HL7 is the preferred method to do it

Efficiency Accuracy

p

Implementing interoperability is similar to any other IT project with several parties involved

Keep stakeholders involvedSell the benefits

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For the BetterFor the BetterFor the BetterFor the Better

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