This document discusses Florida's efforts to implement electronic laboratory ordering and reporting for newborn screening tests from hospitals to the Florida Department of Health. It aims to improve efficiency and timeliness of test result reporting. The project involves developing interfaces between hospital systems and the Florida DOH database. It summarizes the history of reporting for newborn hearing screening and critical congenital heart disease screening. Challenges include hearing data not always being in hospital systems, while successes involve pulse oximetry data availability and support from hospital newborn screening staff. Standards, infrastructure, and past integration experience are leveraged to enable this new partnership and collaboration.

1. Florida Newborn Screening ELO / ELR Project
Early Hearing Detection &Intervention (EHDI)
Pulse Oximetry Reporting in Florida
CCHD/HIT Joint Webinar | March 27, 2015

2. Andrew Richardson
Children’s Medical Services, Florida Dept of Health
Eduardo Gonzalez Loumiet
Data Integration Project Manager, Uber Operations contractor to the Florida Dept
of Health
Speakers Introduction

3. Florida NBS ELO/ELR Project
Project Summary
• Develop and maintain a bi-directional Electronic Laboratory
Ordering (ELO) and Electronic Laboratory Reporting (ELR)
interface between Florida’s hospital Laboratory Information
Management Systems (LIMS) and the Florida Department of
Health’s Bureau of Laboratories for Newborn Screening (NBS)
tests.
• The project would focus on improving the efficiency and
timeliness of Newborn Screening test result reporting, not
only for the BOL, but also for all Florida hospitals.

4. • 220,127 births – 2014
• Universal Newborn Hearing Screening (UNHS)
adopted in 2000
• Critical Congenital Heart Disease (CCHD) adopted in
June of 2014
• UNHS reporting history: Aggregate reporting – to
record level reporting on blood card – to web-based
reporting – to HL7 electronic file reporting.
• CCHD reporting history: record level reporting on
blood card – to HL7 electronic file reporting.
Florida’s Historic Profile

5. Hearing Reporting History
• 2001 – 2002 Aggregate data faxed and mailed from hospitals and stored on
spreadsheets.
• 2002 – 2005 – Received child specific information for referred hearing
results, only.
• 2005 – 2013 – Received child specific data for all hearing screening results.
• June 2013 – current – eReports (web portal)
• In progress – HL7

6. CCHD Reporting History
• January of 2014 – added section on the
blood card for blood card reporting.
• Web portal available for reporting, but not
used.
• HL7 – in progress

7. Florida Blood Card, Today
• Hearing fields available: Hearing Screening Date,
Right ear result (pass or refer), Right ear test
method (OAE or ABR), Left ear result (pass or
refer), Left ear test method (OAE or ABR), hearing
risk status (multiple can be selected – values
available: PPHN, ECMO, Family History, Birth
Weight less than 1500 grams, exchange transfusion
for hyperbilirubinemia), Not screened reason
(Available options: Baby expired, Missed, Birth
defect, facility transfer, not yet screened NICU,
parent/guardian refused).
• CCHD fields available: pulse oximetry date, test
result (options available: pass, fail, not tested), right
hand oxygenation %, lower extremity oxygenation%.
– RH and LE values are the final values recorded after completing the
CCHD screening protocol.

8. The future:
HL7 Electronic Reporting

9. Where data is stored
• Pulse Oximetry Data – hospital EMR
• EHDI/Hearing screening data – varies,
some hospital EMR, some hearing
screening provider data system.
– Our experience - more difficult to get from
outsourced hearing screening entities due to
lack of robust data integration team.

10. How we plan to get the
Hearing and Pulse
Oximetry Data into our
system

11. Enterprise Data Integration
Foundations We Build on
• FDOH Data Integration Program started in 1998 as a
response to requests for ELR for surveillance systems
– Researched available tools
– People are as important as tools – integration is a mindset
as well as a skill set. Training is mandatory
– Started with a small implementation but in a framework
that would scale
• Pilot project – ELR for STD’s resulted in immediate benefits and
gained us support at an Enterprise level
• 15 yrs later and we are processing over
– 4 million lab results for surveillance
– 40 million Immunization transactions
– $200 million in HIPAA Compliant Claims for medical services
– 300 files not requiring transformation
– Our 1st year of processing over 1 million lab orders/requests
– And now our latest project Newborn Screening, which leverages
knowledge gained over the last 15 years.

12. Foundation: Infrastructure

13. Integration Transport
FileMover
Foundation: Tool Belt

14. Foundation: Standards

15. PHLIP RnR
• All Children's
• Labcorp
• Mayo
Direct Send
• 25 US states
• CDC
• Quest
• SNTC
• BBRHIO
• Specialty Labs
• Cerner
• Finlay
• Halifax
• Sarasota
• Clinlab
• Hundreds of trading partners
SFTP
• IRL
• Palm Beach County
• Pilot testing
ELR
ELR DB
Merlin (DSS)
• SQL
• Surveillance
• Palm Beach
IIS
HMS ELO
ELR
HMS (Cache)
67 County HDs
Data Integration Team
• NBS
PRISM
STD

16. Foundation: Experience
• ELR in production in 1999
• Public Health Laboratory Interoperability Project (PHLIP)
• Electronic Laboratory Surveillance Message (ELSM) – influenza results to
the CDC
• Electronic Test Order/Result (ETOR) Salmonella – salmonella orders to the
CDC
• ELC HITECH Project – HL7 2.5.1 between SPHL LIMS, providers, SPHA,
and the CDC.
• PHLIP RnR Hub - development and management
• Laboratory Information Management System Interoperability (LIMSi) project
• A strong working relationship with the Newborn Screening area in the
Children’s Medical Services program
• Pandemic Influenza Project between Florida, Texas, Virginia, and the CDC

17. Standards

18. Registration Form

19. Addendum

20. Challenges Encountered
• Hearing data not in hospital systems,
where we’re getting blood card data set.
• Additional import routine needed for
hearing data.
• Unique identifiers not perfect in hearing
data external to hospitals set. (can
reference UUID of blood card)

21. Successes Encountered
• Pulse ox data in hospital EHRs
• Cerner RLN – hub concept, simplifying
network connectivity.
• Onboarding informationdocumentation.
• positive support from hospital NBS staff
involved in the blood card process, after
hearing presentation on this project.

22. Partnership

23. Collaboration