challenges and benefits of implementing electronic ......challenges and benefits of implementing...

Challenges and Benefits of Implementing Electronic Messaging in Newborn Screening Laboratories

Ashleigh Ragsdale, MPHQA & Development SupervisorNewborn Screening Program

Washington State Department of Health

MSH|^~\&|Neometrics.WA.Prod^2.16.840.1.113883.3.237.4.9ÎSO|WADOHPHL^50D0661453^CLIA||WASHINGTON STATE HOSPITAL^H0999^L|20140502103308344||ORU^R01ÔRU_R01| 2014050200003|P|2.5.1|PID|1||10056832^^^WASHINGTON STATE HOSPITAL &H0999&L^MR||BART SIMPSON||201401211614|M||2106-3^White^HL70005||||||||||||UÛnknown^HL70189||N|0|NK1|1|SIMPSON^MARGE|MTH^Mother^HL70063|ORC|RE|30432902^WASHINGTON STATE HOSPITAL^H0999^L|20140240127^WADOHPHL^50D0661453^CLIA ||||||||||||||||||WASHINGTON STATE HOSPITAL ^^^^^WADOHPHL&50D0661453&CLIA^PI^^^H0999| 123 SPRINGFIELD DR ^^SPRINGFIELD^WA^98902|^^^^^206^5758000|OBR|1|30432902^WASHINGTON STATE HOSPITAL^H0999^L| 20140240127^WADOHPHL^50D0661453^CLIA|54089-8^Newborn screening panel American Health Information Community (AHIC)^LN|||201401220600|||| |||201401240800|||| ||||20140128|||F|OBR|2|30432902^WASHINGTON STATE HOSPITAL ^H0999^L| 20140240127^WADOHPHL^50D0661453^CLIA|57128-1^Newborn Screening Report summary panel^LN|||201401220600|||||||201401240800||||||||20140128|||F|OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN||LA12421-6Înitial screen^LN||||||F|||201401220600|OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3Âcceptable^LN|||N|||F|||201401220600|OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN||LA12428-1Âll screening is in range for the conditions tested^LN|||N|||F|||201401220600|OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN||LA137-2^None^LN|||N|||F|||201401220600|OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN||LA137-2^None^LN|||N|||F|||201401220600|

Getting Started


HIT HIEHL7 2.5.1

Integration EngineMiddleware

LOINC

SNOMED-CT

EMR

EHRLIMS

Implementation Guide

System Architecture

Bidirectional Messaging

Interoperabilty

Validation

Meaningful Use

Hierarchic Designator

Challenge: Assemble the Team


Informatics

NBS SME

LIMS VendorHL7 Expert

Leadership

Business Analyst

Network Architect

Presenter

Presentation Notes

Identifying the players is critical Some agencies will already have IT systems in place that can be used for NBS. Take advantage of the work that is being done within your agency. Meaningful use initiatives have provided incentives for state agencies to develop infrastructure that supports electronic exchange of health information. Staff turnover Agency priority

Challenge: Adapting the Implementation Guide


Presenter

Presentation Notes

NBS labs are all unique, so fitting to the standard can be a difficult concept.

Challenge: Adapting the Implementation Guide


Use the IG to mimic paper results &

orders

Review current forms and reports

Create a program specific Implementation Guide

One standard message?

Middleware?LOINC Mapping

LIMS Changes

Presenter

Presentation Notes

Brendan just gave an excellent overview of how to use this guide- so I will not go into detail. Work the guide, don’t let the guide work you. The flexibility and optionality of the new guides should allow your program to ‘mimic’ your paper results and orders. You can ask for what you want– changes can be made and new LOINC codes can be developed, but you may also want to review your current forms and reports to and examine the utility of each field. The guide should not be used to drive the program -You need to make a decision, usually with your LIMS vendor, of what your message structure will be. Do you need multiple version of the results – one for normal results and one for abnormal results? Will the messages be different for first screen or second screens? If you need that kind of flexibility do you want your LIMS to produce the messages or should you employee a middleware program to do it for you? You may need to make modifications to your LIMS system Need the SME to help with LOINC mapping Create a program specific implementation guide.

Challenge: Changing Laboratory Workflows


Will specimens be accessioned

differently?

How will we review results? What happens when we make a correction?

Will responsibilities shift?

What do we do if the data doesn’t match?

Current Work Flow Identify areas of change New workflow

Staff buy-in

Presenter

Presentation Notes

First off, change can be difficult, so it is really important to identify the areas for change and work with staff during the transition. In order to be prepared, we need to fully understand the impact to our workflows. Some issues that arise during this are: Know what to expect

LIMS

Testing

Data Entry

ReviewReleasePrint

Mail

Abnormals reviewed by Follow-upReceive specimens


Example: Result Reporting Workflow

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Presenter

Presentation Notes

Allows us to go in an select the mailers we want to run. This allows us to have more control, but it is a manual process, so protocol changes will have to be made to ensure results are sent. The physical print job is a review mechanism that allows us to catch errors before they go out the door. We chose to have this same functionality. When reviewing workflows it is very important to consider that not all of your submitters will be able to participate in electronic messaging. Smaller clinics and out of hospital birth providers will unlikely participate, so workflows for paper orders and results will need to be retained.

Challenge: The Data Exchange Pathway


LIMS

Example:Direct Data Exchange



What is an HIE?

Data warehouse

Pass through Facilitator

Hub

Presenter

Presentation Notes

Health Information Exchange Facilitates access to and retrieval of clinical data to provide safer and more timely, efficient, effective and equitable patient-centered care. Some HIE’s function as a data warehouse, how does this affect the NBS program Some HIEs function as a passthrough or Hub of information. Think of them as the transit station. Standard message formats

LIMS


Example:Statewide HIE

LIMS


Example:Integration Engine


What is an Integration Engine?Pathway

between LIMS and HIE

Filter MessagesTranslate Messages

Transform Messages

Automate Message workflow

Presenter

Presentation Notes

Middleware Pathway between HIE and LIMS Filter messages Translate and transform messages Automate the message work flow- literally pick up and deliver the message Rhapsody to act as a mapping and translating mediator between incompatible systems. connects legacy systems by using a standard messaging protocol.

LIMS

Cancer Registry Notifiable

Conditions

Vaccinations

NBS Lab


Example:Integration Engine

Challenge: Resource Intensive


Challenge: Resource Intensive


Creative FundingMeaningful Use

GrantsCMS

Agency Resources

already in place

Potential for cost savings?

Estimating Costs

Plan for the long-term

DevelopmentImplementation

OnboardingMaintenance

Presenter

Presentation Notes

Biggest challenge outside of finding the time and money to do the project, is estimating what you need. This is new territory and we really do not have a good idea of the resources needed and often before you can get funding or a green light for a project you need to estimate your costs and resources. Our project stalled because we ran into a resource (mostly time and ownership) issue. Cost estimates span through the developments and impl

Additional Challenges – The Unknown


Benefits


Improved TAT

Reduce Carbon Footprint

LIMS

Reduce Data Entry

Saving Babies

Reduce Transcription

EMR

Expedited Access

Improved Accuracy

Build Relationships

Presenter

Presentation Notes

A big expected benefit of electronic messaging is the reduction of errors in our systems. By receiving order directly from the MR we would reduce

HIT Community


HIT Workgroup

HIT List Serve

Building Blocks NBS Health IT

Guide and Toolkit

Washington State Newborn Screening

Ashleigh Ragsdale, MPHQA & Development Supervisor

[email protected](206) 418-5534

ThankYou!!


challenges and benefits of implementing electronic ......challenges and benefits of implementing...

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