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Risk Factors

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									 Colorado’s Maternal and Child
  Health Information System



American Health Information Community
  Population Health and Clinical Care
   Connections Workgroup Meeting
                   April 6, 2008
                Chris Wells, PhDc, MS
 Colorado Department of Public Health and Environment
CSHCN Data Integration System

     CSHCN – Children with Special Health Care
      Needs
     CSHCN Data Integration System (IDS)
         CHIRP – Clinical Health Information Records of
          Patients
         NEST – Needs, Evaluation, Screening and
          Tracking
Brief History
    EHDI (Early Hearing Detection and Intervention)
     grant (October 2000)
        Original 5 year cooperative agreement with CDC
        3 additional EHDI RFPs (2006-2008)
  CHIRP stand-alone applications completed
   2005
  NEST architecture completed July 2006
  CHIRP and NEST applications fully integrated
   November 2006
IDS CHIRP
    CHIRP
      Program/Agency specific
      Customized to track program/agency
       caseload
      Standard/Customized reports

      Standard user manual
IDS CHIRP
    CHIRP Applications
        Newborn Hearing Screening
           Newborn Hearing Follow-up Coordinator
           State Audiologist

        Health Care Program for Children with Special
         Needs (HCP)
             State HCP staff
             14 HCP Regional Offices
             County Nursing Offices
IDS CHIRP
    CHIRP Applications continued
        Traumatic Brain Injury (TBI)
           State HCP Staff for TBI Administration
           Denver Options Staff for TBI Administration

        Newborn Metabolic Screening
             Newborn Metabolic Screening Follow-up Coordinator
        Hemoglobinopathy Screening
             Hemoglobinopathy Follow-up Coordinator
IDS CHIRP
    CHIRP Applications continued
        Sickle Cell Screening
             The Hemoglobinopathy Follow-up Coordinator
             Sickle Cell Clinic staff at The Children’s Hospital (TCH)
        Inherited Metabolic Disease (IMD)
         Screening
             IMD staff at The Children’s Hospital (TCH)
IDS NEST
    NEST
        Centralized database
        Assigns unique identifier to each individual
        Allows CHIRP applications to communicate
        Shares data based on business rules
        Built using Microsoft BizTalk Server
IDS NEST
    NEST incorporates data from:
         CDPHE Vital Records Electronic Birth
         Certificate (EBC)
           Used by the NBH follow-up coordinator to
            identify newborn hearing cases, as well as
            those newborns who missed the screening
           Notify agencies of new information on known
            individuals
           Daily extract
IDS NEST
    NEST incorporates data from:
        State Laboratory and Research Department
         Newborn Metabolic Screening Results
          Used by the NBS follow-up coordinator to
           follow those children with positive or missing
           screens
           Used by the Hemoglobinopathy, Sickle Cell and
           Inherited Metabolic Disease specialty clinics
               – Provide confirmatory diagnostic tests and early
                 intervention efforts
             Daily extract
IDS NEST
    NEST incorporates data from:
        Colorado Responds to Children with Special
         Needs (CRCSN)—CO birth defects registry
           Used by CRCSN to send electronic notifications
            to HCP for possible contact and intervention
           Used by HCP Regional offices and Public Health
            Nurses for care coordination purposes
           Notifications sent 1 time per month
            (350/month)
                    1
                                                                  The Big Picture                                                                                                               Blood spot sent to
                                                                                                                                                                                       2         State Lab (LARS)
                                                                                                                                                                                                for screening tests

         Hospital performs NBH
                                                                                                                                   18           Extract of LARS data
         Screening and Collects
           NBMS Blood spot                      Extract of Electronic Birth         4
                                                                                                           Medical Home
                                              Certificate (EBC) data with                                    or PCP
                                                   NBH Screening results                                                                                                5                        LARS
                                                                                                                                         Providers can access
                                                                                                                                                                                              NBMS Results
                                                                                                                                         their Patient's information
   3                                                                                                                                     Thru VPN

                       EBC w/NBHS
                         Results
                                                                                                              NEST
                                                                                                             Database                                                                       Results of Contacts
        Results of Screening and                                                                                                                                                 14         from PHN
        Birth information given to                                 6
       EBC Clerk by hospital staff                                                                                                                                                                           Existing
                                                                                                                                                                                                              VPN
                                     Notification of screening                                                                                                                                               Access
                                      results referring to sub-
Sub-Specialities:                       speciality from NEST                                                                                                                      HCP IRIS
Sickle Cell Clinic                                                                                                                                                                Database
Inherited Metabolic Diseases                                              Results of Contacts                                                                                       (Case
                                                                                                       Diagnosis confirmation
Newborn Hearing Follow-up                                                 from PHN                                                                         12                    Management)
                                                                                                       Treatments
Newborn Metabolic Follow-up                                       15                                   Interventions
Pediatric Endocrine Clinics                                                                            Requests for PHN Contacts
Cystic Fibrosis                                                                                        by Sub-Specialty                                         Requests for PHN                13
Part C                                                                                        9                                                                 Contacts from NEST
Asthma
Vision Screening                          CHIRP                                                                10
                                                                              Reportable Conditions                                                                                                  State Health
                                         Newborn
                                                                                    from the NEST                                                                                                    Professionals
                                          Hearing
                                         Database

                          7                                                                                 CRCSNs
                                                        8          VPN               16                                                    11                               17
                                                                                                            Database
                                                                   Access
   Follow-up Letters                                                                                                                                                                              Families of
                                                                                                                                                                                                 Children with
                                        Reports                                           Results of Contacts Requests for PHN                                                                  Special Needs
                                                                                          from PHN            Contacts by CRCSN
                                                     CO-Hears                                                 (Birth defects registry)
                                                    Audiologists                                                                                                                 Immunization information
                                               Sub-Speciality Personnel                                                                           Immunization                   from Medical Providers
                                                Medical Professionals                                                                               Database
         Health Care
        Professionals                                                                      Future
        and Families                        Hospital Follow-up


                CHIRP
        Clinical Health Information
                                                Reports

                                                                                                                                         EHDI-NEST                     Newborn Evaluation
                                                                                                                                         Early Hearing
            Records of Patients                                         Hospital Co-ordinators
                                                                                                                                         Detection and                   Screening and
                                                                                                                                          Intervention                     Tracking                  February 18, 2003
Advantages to Integrating Data
  Eliminates illegibility and reduces error
  Facilitates data collection and analysis
   for quality improvement
  Reduces redundancy by eliminating
   double entry
  Automates and improves
   communications
        Automatic generation of letters
Barriers to Integrating Data

    Lack of standardization for data elements
    Sustained resources including personnel
    Different access rules for different data
    Varying consent and confidentiality provisions
    Other statutory and regulatory restrictions
    Resistance to change
    Communication barriers between interested
     parties
Questions?



 Chris Wells, PhDc, MS
 Director, Public Health Informatics Unit
 Office: 303-692-2239
 chris.wells@state.co.us

								
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