Developing web-based heatlh information systems in New Jersey

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Developing web-based heatlh information systems
in New Jersey

• Katherine Hempstead
• Center for Health Statistics
• New Jersey Department of Health and Senior
  Services

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From paper to the web.

• Transition to electronic records occurring
  throughout the health care system
• Benefits to patients, physicians, and government
• But many challenges to overcome

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Three examples

1. Child Health Registry
2. Trauma Registry/Pediatric Critical Care Registry
3. Electronic Death Registration System

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Child Health Registry

• Background
• Since _at_ 1999, HRSA and partners have been working
  to foster development of integrated child health
  systems
• Identified key elements
• Developed principles and core functions
• Disseminated to states
• Grant funding

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Current situation in many states

• Separate child health information systems
• Birth registration
• Newborn screening
• Hearing screening
• Immunizations
• Birth defects registry
• Eligibility screenings

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Problem with current system

• Physicians do not receive timely information in
  many cases
• Patients lost to follow up
• Leads to under- or over-immunization
• Missed opportunities for appropriate care

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Integration of child health information systems

• Goal
• To prevent problems arising from lack of timely,
  accurate, and complete information
• To reinforce concept of a medical home for
  children that contains all information about the
  child
• Facilitate assessment and prompt provision of
  appropriate services

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National activities

• HRSA and partners
• Proposed systematic approach
• Developed user requirements
• Comprehensive evaluation plan
• Communications plan to include all stakeholders
• Document and disseminate best practices

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Developed sourcebook

• 5 key lessons
• 1. Share data
• 2. Listen to stakeholders
• 3. Change is hard
• 4. Let public health needs drive technology
• 5. Stay the course

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Priority areas for integration

• Vital registration
• Newborn dried blood spot screening
• Newborn hearing detection
• Immunization
• Other areas
• WIC, lead screening, special needs registries,
  billing systems, birth defects surveillance,
  early interventions

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Example Utah

• Child Health Advanced Records Management (CHARM)
• Provides real-time access to data
• Reduce duplicate data entry
• Support coordinated service delivery

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CHARM

• Does not replace existing data systems
• Serves as an electronic broker
• Participating programs can link to CHARM share
  data they choose to share
• Participating programs retain stewardship of
  their data

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CHARM

• CHARM Core Council
• Program managers, UDOH senior management,
  technical staff and consultants
• Mechanism for developing a consensus on what is
  to be shared
• Provide input on potential uses of integrated
  data
• Primarily supported by federal grants

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Where are we in New Jersey?

• Vital Registration
• Newborn screening
• Newborn hearing
• Immunization

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Birth Registration

• EBC
• DOS-based
• 1995 Genesis Systems
• PCs using modems enter data from labor and
  delivery centers
• Transmit to local registrars - BVS

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New Jersey Immunization Information System

• Developed in 1997
• http//njiis.doh.state.nj.us/njiis/index.htm
• Contains over 500,000 records
• 2004 law requires participation, unless refusal
• Located in Communicable Disease Service
• Accessible by physicians and other providers

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Early Hearing Detection and Intervention

• Established in 2002 with CDC funding
• Developed internally
• Has been updated and improved
• Monitors hospital compliance
• Does not include out of state transfers

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Newborn Biochemical Screening

• NBS lab located in DHSS (PHEL)
• Mandated to screen for 20 disorders
• Actually screens for somewhat more
• Notifies hospitals of results
• Also notifies NBS Follow-up program
• Follow-up program notifies pediatricians,
  parents, tracks outcomes

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Newborn Biochemical Screening

• Required by law, unless parents object
• Began in 1964
• Has expanded considerably since then
• Results mailed from lab via USPS

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Current level of integration

• EHDI and NJIIS have signed MOA, so that hearing
  data is available to physicians accessing NJIIS
• EHDI and NJIIS receive information from EBC
  weekly files accessed via FTP
• NBS not currently integrated with EBC

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Vision for the future

• Integration of all systems in a web-based data
  mart
• Authorized users can obtain information in real
  time
• EBC information is integrated with screening and
  immunization information
• Pediatricians can access in real time

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Progress toward goals

• Have received HRSA funding to create integrated
  child health registry
• Formed working group
• Drafted RFP
• In process of preparing for bids

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Trauma Registry

• Definition
• Uses of a trauma registry
• Evaluate treatment outcomes
• Proper triage/transfer procedures
• Injury surveillance, prevention activities

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Trauma registry

• Background
• Has legislation to establish state trauma
  registry no rules
• Current status
• Central Nervous System injury registry
• Transition to statewide trauma registry
• Trauma centers
• Other acute care hospitals

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Pediatric critical care registry

• Developed by Governors Emergency Medical
  Services for Children Advisory Council
• Purpose Develop a registry of critically ill or
  injured pediatric patients
• Track outcomes evaluate treatment
• Develop best practices

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Plans for Development

• Web-based registry minimizing duplication
• Will be implemented as part of New Jersey Trauma
  Registry
• Hospitals should begin piloting by Fall 2008
• Challenges

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Electronic Death Registration System
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Electronic Death Registration System

• Benefits of EDRS
• Background
• Current status
• Challenges

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What is EDRS?

• Electronic filing of death certificates
• On-line collaboration among multiple death
  registration system users
• User-friendly death record data entry screens
• Fact-of-Death data
• Cause-of-Death data
• Built-in instructions and on-line/telephone
  helpdesk
• Internet accessibility 24/7
• Electronic authentication
• User IDs/passwords

Adapted from Electronic Death Registration
Systems in the United States Accessed 3/08 from
www.naphsis.org
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Who benefits from an EDRS?

• Physicians and medical examiners
• Institutions
• Hospitals
• Nursing Homes
• Hospice
• Long Term Care
• Funeral directors
• State and Local registrars
• Federal, state and local agencies
• Public health researchers
• Families

Adapted from Electronic Death Registration
Systems in the United States Accessed 3/08 from
www.naphsis.org
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Benefits of NJ-EDRS

• Sends timely email alerts when an electronic
  signature is needed to certify a death
• Staff can quickly and easily enter decedent
  information for physician review and
  certification
• Empowers facilities with reporting features

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United States Electronic Death Registration
Systems, by Jurisdiction, With SSA Funding
Indicator, July 2007
Washington

Maine
Montana
North Dakota
Minnesota



Oregon
VT




New York City
Wisconsin
NH

Idaho

South Dakota
MA


New York
Michigan
CT
Wyoming
RI
Pennsylvania
Iowa

Nebraska
NJ
Nevada

Ohio
Indiana

DE
Utah


Illinois

MD
WV
Colorado
Missouri
Virginia


Kansas
DC
California
Kentucky
N. Carolina
Tennessee
Arizona
Oklahoma
Arkansas
New Mexico
S. Carolina





Georgia
MS
Alabama


Received SSA Funding
LA
Texas

Alaska



Florida

Hawaii
Status
Deployed
In Development
Planning/Requirements Stage
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New Jersey Mandatory EDRS

• Physician use of the EDRS is required by law
• 268-24.1 New Jersey Electronic Death
  Registration System (NJ-EDRS) establishment
• All participants in the death registration
  process, including, but not limited to, the State
  registrar, local registrars, deputy registrars,
  alternate deputy registrars, subregistrars, the
  State medical examiner, county medical examiners,
  funeral directors, attending physicians and
  resident physicians, licensed health care
  facilities, and other public or private
  institutions providing medical care, treatment or
  confinement to persons, shall be required to
  utilize the NJ-EDRS to provide the information
  that is required of them by statute or
  regulation.
• The State Registrar will send official notice
  identifying the date for mandatory compliance
  with this law, but all persons are encouraged to
  begin using the system now.

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Phased Approach to EDRS TrainingPhase I

• Pilot Completed May 2007
• Training of Registrars, Funeral Directors and 3
  medical facilities in the pilot county (Mercer)
• Medical Examiners statewide were trained during
  the pilot
• Phase I June 2007 to Present, Concurrent
  training of
• 566 Local Registrar Offices
• Completion Oct 2007
• 800 Funeral Homes
• Target completion by early 2009
• To date, Funeral Directors have been trained in
  Mercer, Hunterdon, Warren, Sussex, Middlesex,
  Monmouth, Ocean, Burlington, Somerset and Passaic
  counties

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Phased Approach to EDRS Training Phase II-III

• Phase II Training of Medical Facilities
• Hospitals, Long Term Care, Nursing Homes, Hospice
  
• 943 Medical facilities to be trained
• Medical Facilities, staff and affiliated
  physicians will receive training beginning Spring
  of 2008
• Phase III Training of Private Practice
  Physicians
• Training to commence upon the conclusion of Phase
  II
• Physicians can self-register and utilize on-line
  tutorials

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Additional Training Tools

• CD-ROM Tutorial
• Medical Certifier Quick Reference Guide
• EDRS powerpoint presentation
• Posters, fliers, magnets
• 24-hour Help Desk
• Reference Guides for
• Medical Facility Administrators
• Long Term Care
• Hospice
• Nursing Homes

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Simple Physician Self-Registration Go to EDRS
Homepage - https//edrs.nj.gov
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Complete Initial Registration Page
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EDRS User Accounts for the Medical Facility

• The Medical Facility Administrator
• EDRS requires each facility to identify a person
  to serve as an administrator
• Set up and monitor EDRS for the facility
• Affiliate users and manage who is allowed to
  access the facilitys cases
• Serve as an on-site point person for EDRS
  training

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EDRS contact information

• 24 hour-a-day Help Desk
• By phone [phone]
• By email helpdesk_at_doh.state.nj.us

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New Jersey Health Information Technology
Commission

• Established under P.L. 2007, c.330
• New Jersey Health Information Technology Act
• To work with Office of e-HIT (DOBI)
• Responsible for approving state health
  information technology plan
• Development of electronic medical records

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New Jersey Health Information .,..

• Background
• Authorizing legislation
• Current status

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RHIOS

• Current status

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Private Sector initiatives
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Federal government initiatives
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Overview

• What we can expect