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Linking Nbs To Ehr 130410


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This is a presentation I recently gave in a scientific conference in Doha, Qatar.

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Linking Nbs To Ehr 130410

  1. 1. Linking Newborn Screening to Electronic Health records MENA NBS DD conference, Doha, Qatar April 29th 2010 Kari Klossner Director, Market and Sales Development 1 © 2009 PerkinElmer
  2. 2. My Topics Overview of EHRs, HL7 and how they can benefit NBS Practical considerations in this field Lessons learned Q&A 2
  3. 3. EHR, HL7, EHR HL7 and NBS 3 © 2009 PerkinElmer
  4. 4. What is an EHR… (also electronic / computerized patient record) A textbook definition from 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, radiology images, and billi iinformation. di l i d billing f ti 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 p in health care settings and to increase safety through evidence-based decision support, quality management, and outcomes reporting 4
  5. 5. Why EHR – Key motivations to invest Reduce costs Elimination of duplicated efforts Reduction of errors Improved quality of care Can reduce medical errors by providing HC workers with decision support. Fast F t access t medicall literature & best practices improve h lth to di lit t b t ti i healthcare efficacy. ffi Promote evidence based medicine evidence-based EHRs give access to unprecedented amounts of clinical data for research Can accelerate the level of knowledge of effective medical practices. Support record keeping and mobility EHR’s can connect to many electronic medical record systems. In the current global medical environment patients are shopping for their procedures. environment, procedures 5
  6. 6. Introduction to EHR and HL7 HL7 is an organization Founded 1987, HQ in Ann Arbor, MI, USA, Non profit, ANSI-accredited standards development organization Exchange, integration, sharing, and retrievall of electronic h lth E h i t ti h i d ti f l t i health information > 2,300 members worldwide > 500 corporate members… > 90% of healthcare IT vendors p 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 6
  7. 7. Interoperability in newborn screening Where can newborn screening realize the greatest benefits? Birthing center NBS Lab HC Provider Results R lt Demographics Recommendations Requests Manual manipulation of data = Opportunity to apply interoperability 7
  8. 8. Change in process… the Old Way vs the New Way Birthing Bi thi center t Birthing Bi thi center t 1. Sample is taken 1. Sample is taken 2. Demographics are recorded 2. Demographics are recorded 3. Blood card is mailed to the lab 3. Blood card is mailed to the lab Newborn Screening Lab Newborn Screening Lab 4. Blood card is received at the lab 4. Blood card is received at the lab 5. Information is recorded into computer Opportunity (Entry automated via interoperability) 6. Analysis is p y performed for Human 5. Analysis 5 A l i iis performed f d 7. Report is printed Error (Reporting automated via interoperability) 8. Report is mailed to provider Redundant, Report non value adding, repetitive HC Provider HC Provider work 9. 9 Report is received (Receiving automated via interoperability) 10. Information is recorded into computer ELIMINATED 11. Results are communicated to family 6. Results are communicated to family 8
  9. 9. The challenge is shared and seen by many…. Differences in regional practices & regulations Test panels are very different p y Testing and reporting methods differ customer to customer Solutions There are no blood card data or format standards tailored to customer specific Developing interoperability standards needs Universal electronic coding and transmission standards are just now becoming available (HRSA / NLM) 99 …but solutions are different and diverse
  10. 10. Practical considerations on EHR/HL7 interoperability in NBS p y 10 © 2009 PerkinElmer
  11. 11. Key goals for laboratories to pursue with EHR interoperability Statistical accuracy Reduce Laboratory efficiency Demographic data entry errors Time spent in data entry Increase Turn around time Typically, following areas of application considered: Laboratory Results nd nd Recommendations Outboun Inboun Demographic import D hi i Repeat requests Testing requests Follow-up ST & LT Billing 11
  12. 12. Highlighting a few real life g g g examples… 12
  13. 13. Alberta, Canada British Columbia, Canada Outbound only Leeds, UK Inbound/Outbound Customized solution, HL7 v2.2 Customized solution, HL7 v2.3 Integration with provincial health Go-live 2Q 2010 Integration with a HIMS network Inbound + Outbound xChange, HL7 v3 Integration with NHS Spine Zurich, Switzerland Go-live 2H 2010 Inbound + Outbound xChange, HL7 v2.2 Integration to national hospital network Ohio, USA Kentucky, USA Illinois, USA Go-live 2Q 2010 Go-live 2Q 2010 Requirements gathering Inbound + Outbound Outbound only Inbound + Outbound Customized solution, HL7 v2.3 xChange, HL7 v2.5.1 xChange, HL7 v2.5.1 (upgrade to v2.5.1 + HITSP IS HITSP IS 92 NBS standards, S S9 S s a da ds, Use HITSP IS 92 NBS S S9 S 92 NBS standards), Integrations t d d ) I t ti Integration with state health standards (proposed) with multiple hospital information information exchange Integrations TBD systems 13
  14. 14. Typical NBS Interoperability Architecture – Big Picture Laboratory Information System Interoperability Layer Message Outbound Outbound Triggering Message Messages LIMS Vendor’s Event Procedure Table Service EHR Partner System Data Tables Outsource System Laboratory Data Inbound Inbound Validation Message Messages Engine Procedure Table LIMS Database Typically a PRODUCT a PRODUCT, a SERVICE Typically regional developed by a commercial LIMS vendor or a combination health organization developed by a LIMS vendor, a e.g. NHS SPINE in UK Partner, or the Laboratory 14 14
  15. 15. Alberta – outbound only, laboratory managed messaging Laboratory Information System Interoperability Layer Message Outbound Outbound Triggering Message Messages Event Procedure HL7 V2.2 Table EHR Partner System Data Tables System Laboratory LIMS Database CloverLeaf Provincial H l h P i i l Health Network 15 15
  16. 16. Kentucky – outbound only, partner managed messaging Laboratory Information System Interoperability Layer Message Outbound Outbound Triggering Message Messages Event Procedure HL7 V2.5.1 Table System Data Tables Partner KHIE Outsource HITSP IS* 92 Interoperability LIMS Database Commonwealth of C lh f Kentucky Health Information Exchange * The Healthcare Information Technology Standards Panel (HITSP) Interoperability Specification (IS) 16 16
  17. 17. Leeds – bidirectional, partner managed messaging Laboratory Information System Interoperability Layer Message Outbound Outbound Triggering Message Messages Event Procedure HL7 V3 Table NHS Partner System Data Tables Outsource Spine Data Inbound Inbound Validation Message Messages Engine Procedure Table LIMS Database SmartWorks National H l h S i N i l Health Service network backbone 17 17
  18. 18. Leeds and the NHS Connecting for Health (CfH) program P t of the UK Nationall Health System (NHS) Part f th N ti H lth S t Birmingham Bristol CfH goal: make EHRs available for all NHS patients Cambridge Cardiff Anywhere in the country Newcastle Glasgow By means of the NHS spine network Leeds Liverpool Great Ormond Street Central Middlesex Pilot project: Leeds St. James Hospital Carshalton Lewisham L i h First step outbound data Manchester Oxford Go live April 2010 Portsmouth Sheffield Second step inbound data Next roll out from region to country Goal to connect all UK NBS labs to NHS net 18
  19. 19. Key motivations* at St James’ to implement NBS interoperability Ensure every baby gets screened by Much quicker data entry checking against birth records Get better data faster Missing a baby would have - disastrous consequences - major financial liability Safeguard Speed No printing Eliminate human No envelopes No stampsp Efficiency Accuracy errors in transcription No mailman * Based on an interview with Dr. Mick Henderson, St.James’ Hospital, Leeds, UK 19
  20. 20. Lessons learned Laboratory All typical lessons learned from an IT project apply… cannot overstate the importance of: Submitter Consultant(s) (hospital) Getting buy-in from stakeholders & key p y g y y players Several key Setting right expectations players all Creating a solid specification have to work together Professional execution and monitoring g HIMS vendor HL7 integrator LIMS 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 up Have to “sell” to submitters – “what’s in it for us” 20
  21. 21. Benefits realized by the community “The effects on turnaround time are huge” 1 No postal delay for reporting results saves 2-3 days “HL7 increases the lab’s efficiency” 1,2 Reduces the lab’s call volume Data 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 data No manual entry of results into downstream electronic systems “Our data is more accessible” 1,2 Downstream systems offer 24x7 access to results Doctors can access patients’ results online, from almost anywhere p , y 1. Shaina Archer, Genetic Counselor, Alberta Health Services, Edmonton, Alberta CA 21 2. Graham Sinclair, Biochemical Geneticist, BC Children’s Hospital, Vancouver, British Columbia CA
  22. 22. What should you expect from your vendor… Provide the • Support common messaging stds & xmission protocols best solution • HIT SP IS92 for NBS, HL7, LOINC, SNOMED , , , • Maintain awareness of national and regional standards available while meeting customer data exchange requirements • Develop innovative solutions to interoperability challenges today t d • Adhere to privacy laws and regulations Develop • Collaborate w/ interoperability standardization initiatives internationally and regionally HRSA NLM standardized • Offer system architecture for common communication interface to products solutions for • Proactively make interoperability tools as features of future product • Provide flexible interoperability capabilities the future • S Support customer needs as their regulations change d h i l i h 22 22 …to stay flexible to meet customer expectations
  23. 23. Summary Interoperability hold great promise for NBS Inbound data Outbound data Safeguard Speed Key benefits can be realized several areas…… Efficiency Accuracy EHR is the other party your lab connects with HL7 is the preferred method to do it p Implementing interoperability is similar to any other IT project with several parties involved Keep stakeholders involved Sell the benefits 23
  24. 24. For the Better 24