This is a presentation I recently gave in a scientific conference in Doha, Qatar. http://www.hmc.org.qa/3rdnewborn/qatar.htm

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. My Topics
Overview of EHRs, HL7 and how they can benefit NBS
Practical considerations in this field
Lessons learned
Q&A
2

3. EHR, HL7,
EHR HL7 and NBS
3 © 2009 PerkinElmer

4. 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,
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. 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. 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. 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. 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. 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. Practical considerations
on
EHR/HL7
interoperability in NBS
p y
10 © 2009 PerkinElmer

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. Highlighting a few real life
g g g
examples…
12

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. 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. 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. 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
http://www.mirthcorp.com/
* The Healthcare Information Technology Standards Panel (HITSP) Interoperability Specification (IS)
16
16

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. 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. 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. 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. 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. 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. 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. For the Better
24