linking nbs to ehr 130410
TRANSCRIPT
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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
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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
33 © 2009 PerkinElmer© 2009 PerkinElmer© 2009 PerkinElmer© 2009 PerkinElmer
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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.
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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)
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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
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Practical considerations on on EHR/HL7interoperability in NBSp y
1010 © 2009 PerkinElmer© 2009 PerkinElmer
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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
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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
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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
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Partner, or theLaboratory
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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
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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)
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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
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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
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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
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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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